The novel coronavirus, COVID-19, has been declared a global pandemic by the World Health Organization, and a national emergency related to the COVID-19 global pandemic was declared on March 13, 2020. COVID-19 is extremely contagious.

In order to mitigate the risks associated with COVID-19, National Medical Association (“NMA”) has instituted safety guidelines, precautions, and preventative measures that all must strictly comply with while on NMA premises and/or at NMA sponsored events:
  • All registrants and guests will be expected to follow CDC guidance and local and state public health requirements
  • All attendees and guests will be required to wear a mask at all times in public indoor spaces covering the nose and mouth.
  • All attendees will adhere to appropriate social distancing protocols and respect other’s personal space.
  • If you exhibit COVID-19 symptoms, notify NMA staff, isolate and cease participation in the conference.
By signing this Release, I, on behalf of myself, my children, my parents, my heirs, and personal representatives, agree as follows:

  1. I understand that there is presently community spread of COVID-19.
  2. I recognize that NMA is taking reasonable precautions and has put in place preventive measures to reduce the spread of COVID-19. I expressly agree to strictly comply with the COVID-19 Safety Guidelines instituted by NMA to reduce the spread of COVID-19, and that my failure to do so will result in NMA dismissing me as a participant at this event.
  3. I understand that such risks cannot be eliminated entirely, and that although reasonable precautions are taken, I may become infected with COVID-19. I also understand the health risks associated with COVID-19 infection, and  that infection by  COVID-19 may  be serious with  the potential  for significant negative health effects, to myself and/or others, including hospitalization, long-term complications, or death.
  4. I acknowledge the contagious nature of COVID-19 and agree to accept and assume all risks associated with COVID-19 related to my services as a participant at this event, despite the risks of COVID-19.
  5. I, ON BEHALF OF MYSELF, MY CHILDREN, MY PARENTS, MY HEIRS, ASSIGNS, AND PERSONAL REPRESENTATIVES HEREBY VOLUNTARILY WAIVE, RELEASE, AND FOREVER DISCHARGE ANY AND ALL CLAIMS AGAINST NMA, ITS AGENTS, SERVANTS, EMPLOYEES, INSURERS, DIRECTORS, OFFICERS, SUCCESSORS, AND ASSIGNS, THAT RELATE IN ANY WAY TO COVID-19, INCLUDING BUT NOT LIMITED TO ANY CLAIM ARISING FROM OR RELATING TO MY EXPOSURE TO, INFECTION WITH, OR OTHER HARM RELATED TO COVID-19 WHILE PARTICIPATING AT THIS EVENT AND/OR FOLLOWING MY PARTICIPATION SERVICES, AND ALSO INCLUDING HARM RELATED TO MY SPREAD OF COVID-19 TO MY FAMILY MEMBERS OR OTHERS (“COVID Claim”).
  6. I further covenant and agree not to institute any legal action against NMA for any COVID Claim released by this Assumption of Risk and Waiver of Liability Regarding Coronavirus/COVID-19 (“Waiver”). I agree that should any COVID Claim be made against NMA in contravention of this Waiver, including but not limited to derivative claims, I will protect, defend, and completely indemnify (reimburse) NMA for any such COVID Claim and expenses, including attorneys’ fees and costs incurred by NMA in defending itself or security indemnity hereunder.
I have read the Waiver and understand that by signing the Waiver I have consented to be bound by its terms, including the waiver/release of any legal right I may have to sue NMA for any costs it incurs because a COVID Claim is brought in violation of this Waiver. I agree any violation of the Waiver and its terms and conditions, as determined by NMA, may result in loss of the ability to use the facility. I am signing this Waiver freely, voluntarily, and competently

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* 1. Name

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* 2. Email Address:

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* 3. Have you had any COVID symptoms?

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* 4. Have you been in close physical contact, in the last 10 days, with anyone who has had COVID?

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* 5. I am vaccinated and will provide proof (date/serial) uploaded below for the following:
  • Vax #1
  • Vax #2
  • Booster #1
  • Booster #2
(We encourage you to bring an electronic copy/photo of vax card to the convention)

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I attest that the information I am providing regarding my vaccination status is accurate. 

If I am unvaccinated, I am aware that in order to participate in the NMA Convention and Scientific Assembly I need to provide an exemption letter sent to memberservices@nmanet.org with SUBJECT: COVID-19 Exemption AND will need to provide proof of a negative PCR within 72 hours of arrival at the meeting AND a negative antigen test on arrival prior to obtaining conference credentials.

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* 6. I attest that the above information I am providing regarding my vaccination status is accurate. By printing your name below, you are attesting to the NMA Assumption of Risk and Waiver of Liability Regarding Coronavirus/COVID-19.

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* 7. Date:

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