COVID-19 Vaccine Self-Certification

As part of our goal to ensure the safety of all attendees, we are asking you to provide information about your COVID-19 vaccination status.

This information will only be seen by the event organizers and will not be shared with anyone, or used for purposes other than to get an understanding of the percentage of vaccinated people who are attending.

Please fill out this form by October 12, 2021.

Name(Required)
Vaccination Status(Required)