S2 member & amr users

Username *

Email Address *

First Name *

Last Name *

Covid contact in last 2 weeks? * Covid contact in last 2 weeks?

Vaccination Agreement * Vaccination Agreement

Covid Status *
Had it once   Had it twice   Never had it   Antibodies Detected

Precautions Taken *
Masks worn in close quarters, indoor   Socially Distanced   Isolated, stayed home   Washed Hands regularly   None of the above

Location Type during Covid *
Rural   Suburban   City   Outback, extremely isolated place   Desert Island   Cruise Ship   Aged care, hostel, boarding house

Major Achievement during Covid
Describe something you are proud you did during covid: Baked? Dreamed up new cocktails, wrote your novel?

Covid One Liner

Date you heard of covid (approx)

Email for covid results

Emergency Phone *

Domain Name *

Full url with http/s *

Number

Favourite Integer

A floating number

Registration confirmation will be emailed to you.