CPS Fairbanks Quarantine reservation form

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* 1. Traveler Name (Last Name, First Name, Middle Inititial)

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* 2. Traveler Email

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* 3. Traveler Cell Phone Number

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* 4. Lead PI and NSF Grant #

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* 5. Name of university/institution employed by

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* 6. Field Location

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* 7. If traveling to Toolik, please provide the mode of transportation to Toolik Field Station

TFS Shuttle

CPS provided truck

Own Vehicle

Other

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* 8. Arrival date to Fairbanks, AK

Arrival Date

Date

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* 9. Intended departure date from Fairbanks AK [note that 14 full days are required]

Date

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* 10. Do you want CPS to provide a PPE kit for your travels?

Yes

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* 11. If Yes, please provide a mailing address.

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

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* 12. Are you interested in attending a remote Arctic Field Training while you are in quarantine?

Yes

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* 13. Emergency Contact (Name and phone number)

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* 14. Please add any other information in the box below

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* 15. By clicking this box I understand that CPS will be obtaining COVID test results. I agree that they can share this health information with me via email.

Agree

CPS Fairbanks Quarantine reservation form

Question Title

* 1. Traveler Name (Last Name, First Name, Middle Inititial)

Question Title

* 2. Traveler Email

Question Title

* 3. Traveler Cell Phone Number

Question Title

* 4. Lead PI and NSF Grant #

Question Title

* 5. Name of university/institution employed by

Question Title

* 6. Field Location

Question Title

* 7. If traveling to Toolik, please provide the mode of transportation to Toolik Field Station

Question Title

* 8. Arrival date to Fairbanks, AK

Question Title

* 9. Intended departure date from Fairbanks AK [note that 14 full days are required]

Question Title

* 10. Do you want CPS to provide a PPE kit for your travels?

Question Title

* 11. If Yes, please provide a mailing address.

Question Title

* 12. Are you interested in attending a remote Arctic Field Training while you are in quarantine?

Question Title

* 13. Emergency Contact (Name and phone number)

Question Title

* 14. Please add any other information in the box below

Question Title

* 15. ﻿By clicking this box I understand that CPS will be obtaining COVID test results. I agree that they can share this health information with me via email.

* 15. By clicking this box I understand that CPS will be obtaining COVID test results. I agree that they can share this health information with me via email.