AMGA AC22 Vaccination Attestation

As part of our efforts to provide a safe event environment, AMGA is requesting attendees and sponsors to provide a vaccine attestation statement. All AMGA staff participating in the AMGA annual conference are fully vaccinated. Contracted vendors have attested to vaccination at this time. Mandalay Bay has also maintained attestation statements and proof of vaccination for their associates who will have access to shared and public spaces in the hotel while AMGA's 2022 conference takes place.  

Please complete this form to let us know whether and when you have received the vaccine. Information provided within this form will be kept confidential. We are asking for dates of the vaccination to help determine when each participant is considered fully vaccinated. When completing this form, do not provide any medical information, or any other information related to why you may not have received a COVID-19 vaccine. Simply fill in your name, fill in your response. If your situation changes in the future, please provide an updated attestation at that time.

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* 1. Name

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* 2. Email

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* 3. I received the complete series of the COVID-19 vaccine as of date indicated (enter date).

Date

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* 4. Will you be fully vaccinated with COVID-19 vaccine at the time of AC22, March 9, 2022?  (please do not provide any additional information).

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* 5. Enter initials to sign attestation

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