Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920I confirm that I am not presenting any of these COVID-19 symptoms: fever, shortness of breath, dry cough, runny nose, sore throat (please initial) *I confirm that I have not been in contact with a person who has been diagnosed with COVID-19 within the past 14 days (please initial) *I understand that air travel significantly increases my risk of contracting and transmitting the Covid-19 virus. The CDC recommends social distancing of at least 6 feet for a period of 14 days for anyone who has recently traveled (please initial) *I verify that I have not traveled outside the United States within the past 14 days (please initial) *I verify that I have not traveled domestically within the United States by commercial airline, bus or train within the past 14 days (please initial) *NameSubmit