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FORM MEDICAL HISTORY
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* Indicates required question
Email
*
Your email
Delegation Name
*
Your answer
Date Of Birth
*
Your answer
Nationality
*
Your answer
Are you have any allergies?
Food/Medical/Insects
*
Yes
No
If yes please list and indicate type of reaction
FOOD
Your answer
MEDICATION
Your answer
INSECTS
Your answer
Are you suffer for ?
(If yes, please contact the medical team to supply medicine)
*
Ashtma
Hypertension
Heart Disease
Diabetes Mellitus
Seizure
Other:
Required
If yes please list and indicate type of reaction
Your answer
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