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COVID-19 TEST BOOKING

Registration Information(信息录入)

Personal Information(个人信息)

Full Name(姓名)*

Phone Number(手机号)*

Email Address(邮箱) *

Nationality(国籍)

Date of Birth(出生日期)*

Sex(性别)*

State of Residence(所在州)

Residential Add.(住址)

Passport Number(护照号)

Final Destination(最终目的地：)