Exhibition Preview Reception RSVP Form | Nassau County Museum of Art

Name *

First

Last

Date of Birth (MM/DD/YYYY) *

Address *

Telephone Number *

Email *

Are you a Museum Member? *

Yes
No

I have received the complete vaccination series for Covid-19: *

Yes
No

If you have not been vaccinated, you have not been completely vaccinated, or you are unable to prove that you have completed your Covid-19 vaccine series: have you tested negative for Covid-19 no more than 72 hours prior to the event? *

Yes
No
I have been completely vaccinated.

I will *

attend the opening reception
not attend the opening reception

I will be bringing additional guests *

Yes
No

If you are bringing additional guests, please list the name, date of birth, contact information, and vaccination/test status for each guest. *

In attending this event, I will adhere to CDC guidelines and *

show proof of vaccination or Covid-19 test results
wear a mask at all times except when eating or drinking
socially distance
I have no known Covid-19 exposures.
I am not currently experiencing symptoms of Covid-19.