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COVID-19 QUESTIONNAIRE
COVID-19 QUESTIONNAIRE.
Sorors Only.
Please take this questionnaire in advance of chapter meeting.
*
Indicates required field
Name
*
First
Last
Phone
*
Email
*
Do you currently have a fever?
*
Yes
No
Do you have excessive cough and/or difficulty breathing?
*
Yes
No
Are you experiencing new loss of taste or smell?
*
Yes
No
Have you been in contact with someone confirmed with corona virus infection?
*
Yes
No
Submit
Home
Programs
Jabberwock 2022
Youth Programs
>
Delta Academy
Delta GEMS
EMBODI
Risk Management
Scholarship
>
2022 Scholarship Application
Crimson Pages
About
LAC Leadership
Membership
Events
Delta Day at the Races
Candidate Meet & Greet
Contact
Sorors Only
Membership Dues
Forms
Members Only
Covid-19
Delta Dears
Forms