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The COVID-19 Vaccine Latinx Physician Task Force
Video Submission Form
9
Questions
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Language
English (US)
Español
1
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2
Name
First Name
Last Name
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3
E-mail
example@example.com
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4
Name of Hospital/Clinic
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5
City & State of Hospital/Clinic
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6
Please submit your short video and/or photo here.
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7
Do You Agree to the Terms Above?
Yes, I do
No, I don't
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8
Upload Video
Please try to limit your video to a 3-second clip. One powerful phrase.
Drag and drop files here
Select files to upload
Upload a File
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9
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