3P OTAN - events.jftc.nato.int

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NATO UNCLASSIFIED Releasable to NATO RESPONSE FORCE I d~ NATO -\3P OTAN I JFC (~) NAPf.ES /1 HEADQUARTERS ALLIED JOINT FORCE COMMAND NAPLES QUARTIER GENERAL DU COMMANDEMENT INTERALLIE DE FORCES INTERARMEES NAPLES Via Madonna del Pantano, 80014 Giugliano in Campania, Loc. Lago Patria, Naples, Italy Our ref: JFCNP/PLANS/J7/AK/21-04546 Date: a.~ Jul2021 Tel: +39-081-721 + 3124/5169 NCN: 433 + 3124/5169 Fax: +39-081-721-2719 (Registry) TO: See Distribution SUBJECT: INVITATION LETTER - EXERCISE STEADFAST JUPITER 2022 CORE PLANNING TEAM MEETING 2 (CPTM2), 13 TO 16 SEP 21 REFERENCES: A. Bi-SC Directive 075-003 Collective Training and Exercises - Working Draft, dated 28 January 2020 B. COS SHAPE Order/ Staff Order No 135: Officer Scheduling the Exercise Guidance for the STEADFAST JUPITER 2022 Exercise Process, dated 19 October 2020 C. JFCNP/PLANS/J7/AK/21-04272, ST JU22 CPT Activation, dated 12 May 2021 D. SH/SDP/J7 TRXlEPS/JH/21-008884, Support to Exercise STEADFAST JUPITER 2022 from Nations, dated 24 Jun 21 1. Background. ST JU22 is a SHAPE sponsored strategic, operational and tactical level major CPXlCAX that will train SHAPE, JFCNP, NRF23, SFN, NCS JFAC, MNCG, JSEC/SJLSG, Multi-Corps (MC) Land Component Command (LCC) and TCCs, in planning for and conducting an Article 5 multi-JOA theatre operation. ST JU22 will exercise the full range of alliance activity from Enhanced Vigilance through to Defence, with a continued focus on Modern C2, Joint Effects and Enablement, for high intensity warfighting against a peer/near-peer adversary. 2. In accordance with Reference B, COM JFCNP as the OCE is responsible for leading the detailed Stage 2 Exercise Planning, Stage 3 Exercise Execution and Stage 4 Evaluation of the NATO Exercise Process (EP). 3. Aim. The aim of CPTM2 is to build upon progress at IPC and EP activity since in the detailed planning for Exercise delivery and prepare for the Main Planning Conference (MPC) in Nov 21. A particular focus will be on participation of NATO nations in ST JU22, invited at Reference D and who are strongly encouraged to participate in CPTM2 as physical attendees. 4. Location and time. ST JU22 CPTM2 is to be held from Mon 13 to Thu 16 Sep 21; venue for CPTM2 is JFTC in Bydgoszcz, POL. Due to COVID-19 pandemic travel and health force protection measures the format will be a 'hybrid' conference; key CPT members will attend JFTC in person while the wider stakeholder community will be linked in from their peacetime Command/ unit locations by NS VTC. A major STRATCOM event at JFCNP on Fri 17 Sep means that even with this hybrid format, the wider OCE CPT members remaining in JFCNP will 1 NATO UNCLASSIFIED

Transcript of 3P OTAN - events.jftc.nato.int

NATO UNCLASSIFIED Releasable to NATO RESPONSE FORCE

I

d~ NATO -\3P OTAN

I

JFC (~) NAPf.ES /1

HEADQUARTERS ALLIED JOINT FORCE COMMAND NAPLES

QUARTIER GENERAL DU COMMANDEMENT INTERALLIE DE FORCES INTERARMEES NAPLES

Via Madonna del Pantano, 80014 Giugliano in Campania, Loc. Lago Patria, Naples, Italy

Our ref: JFCNP/PLANS/J7/AK/21-04546

Date: a.~ Jul2021

Tel: +39-081-721 + 3124/5169 NCN: 433 + 3124/5169 Fax: +39-081-721-2719 (Registry)

TO: See Distribution

SUBJECT: INVITATION LETTER - EXERCISE STEADFAST JUPITER 2022 CORE PLANNING TEAM MEETING 2 (CPTM2), 13 TO 16 SEP 21

REFERENCES: A. Bi-SC Directive 075-003 Collective Training and Exercises - Working Draft, dated 28 January 2020 B. COS SHAPE Order/ Staff Order No 135: Officer Scheduling the Exercise Guidance for the STEADFAST JUPITER 2022 Exercise Process, dated 19 October 2020 C. JFCNP/PLANS/J7/AK/21-04272, ST JU22 CPT Activation, dated 12 May 2021 D. SH/SDP/J7 TRXlEPS/JH/21-008884, Support to Exercise STEADFAST JUPITER 2022 from Nations, dated 24 Jun 21

1. Background. ST JU22 is a SHAPE sponsored strategic, operational and tactical level major CPXlCAX that will train SHAPE, JFCNP, NRF23, SFN, NCS JFAC, MNCG, JSEC/SJLSG, Multi-Corps (MC) Land Component Command (LCC) and TCCs, in planning for and conducting an Article 5 multi-JOA theatre operation. ST JU22 will exercise the full range of alliance activity from Enhanced Vigilance through to Defence, with a continued focus on Modern C2, Joint Effects and Enablement, for high intensity warfighting against a peer/near-peer adversary.

2. In accordance with Reference B, COM JFCNP as the OCE is responsible for leading the detailed Stage 2 Exercise Planning, Stage 3 Exercise Execution and Stage 4 Evaluation of the NATO Exercise Process (EP).

3. Aim. The aim of CPTM2 is to build upon progress at IPC and EP activity since in the detailed planning for Exercise delivery and prepare for the Main Planning Conference (MPC) in Nov 21. A particular focus will be on participation of NATO nations in ST JU22, invited at Reference D and who are strongly encouraged to participate in CPTM2 as physical attendees.

4. Location and time. ST JU22 CPTM2 is to be held from Mon 13 to Thu 16 Sep 21; venue for CPTM2 is JFTC in Bydgoszcz, POL. Due to COVID-19 pandemic travel and health force protection measures the format will be a 'hybrid' conference; key CPT members will attend JFTC in person while the wider stakeholder community will be linked in from their peacetime Command/ unit locations by NS VTC. A major STRATCOM event at JFCNP on Fri 17 Sep means that even with this hybrid format, the wider OCE CPT members remaining in JFCNP will

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not be available to participate and therefore the CPTM must conclude on 16 Sep 21. Note that 16 Sep will be a full working day and attendees are requested not to arrange travel that will necessitate an early departure prior to meeting close at 1700.

5. Participation. Health force protection remains a priority and social distancing pandemic control measures remain in force. This limits the numbers of personnel who can be accommodated in the working environment. Therefore CPTM2 attendance is limited to 90 external participants, allocation of these 90 spaces by exercise participants is at Annex A. The administrative information for ST JU22 CPTM2 in person attendance at JFTC is at Annex B. External attendees are requested to register through WAFER during the registration window ending Mon 23 Aug 21, informing aCE aPR by email of nominations so that the number of attendees can be controlled. All other CPTM participants who will be joining remotely via NS VTC are requested to confirm their contact details (including email addresses) NL T 06 Sep 21 to the ST JU22 aCE aPR team identified at para 9 below so that final detailed agenda and instructions can be distributed directly.

6. Agenda and Administration. Detailed agenda and syndicate programmes of work will be promulgated in due course once the outcomes from IPC have been fully digested. This letter however enables action to be taken to attend or participate virtually as required. Security classification for this event will be NATO UNCLASSIFIED (tbc), but given that it will be hosted on NS VTC, this can be increased if required, and discussions may range up to NATO SECRET.

7. COVID-19 Considerations. It remains each individual's responsibility to understand and abide by any travel restrictions and regulations pertinent to their personal journey. Specific pandemic control instructions at JFTC are included at Annex C, but travellers should check latest guidance for any updates.

8. Tasks and Responsibilities

a. All Participants. Exercise Participants will need to contribute to CPTM2 with knowledgeable and empowered representatives to represent their interests in the plenary sessions and syndicate work. Please be prepared to discuss the items at issue from the recent IPC and report back progress made since that event and to provide contributions endorsed by your leadership of arising issues and factors.

b. JFCNP Plans J7. aCE aPR will chair CPTM2 supported by the exercise participant and stakeholder representatives of the CPT.

9. Support. aCE aPR will be responsible for the management of CPTM2 information published at: https://nip.jfcnp.nato.intledms/exercises-stju22/public/Forms/Areas.aspx

10. OCE Points of Contact. The JFCNP points of contact for any matters concerning Exercise ST JU22 are:

a. aCE ST JU22 apR: Cdr Alex KENDRICK; JFCNP J7 TREX, +39 081 721 5640 I NCN: 433 5640, NS/NU: [email protected] 0039 335 7832478.

b. aCE ST JU22 Co-apR: Cdr Dan WALKER; JFCNP J7 TREX, +39 081 721 3423 I NCN: 433 3423, NS/NU: [email protected].

c. aCE STJU22 Clerk: Sgt Claudine LAMY DA SILVA; JFCNP J7 TREX, +39081 721 5802 I NCN: 433 5802, NS/NU: [email protected].

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d. ST JU22 Group mailbox: [email protected].

11. JFTC Point of Contact. JFCNP as OCE is responsible for the event, however point of contact at JFTC as the venue is:

a. JFTC Protocol and Conference Support: LTC Barbara LATOCHA, BH PCS, +48 261 41 1482 I NCN: 243 1482, NS/NU: [email protected]

FOR THE CHIEF OF STAFF:

John MEAD OBE Major General, GBR Army Deputy Chief of Staff Plans

ANNEXES:

A. Personnel Attendance Allocations and Working Routines for ST JU22 CPTM2 B JFTC Administrative and Event Registration Instructions for ST JU22 CPTM2 C. JFTC COVID-19 Precautionary Measures For Visitors/ Event Participants

DISTRIBUTION:

External:

Action:

SHAPE SACT JFCBS JFCNF JWC JALLC NCISG NCIA NSPA PLT CyOC AIRCOM MARCOM LANDCOM NSHO SJLSG JSEC SFN 1GNC DEU CJ CBRND-TF HO (through the NMR of Germany to SHAPE)

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DEU SOCC (through the NMR of Germany to SHAPE) TUR MARFOR (through the NMR of Turkey to SHAPE) JLSGNP JFTC CBRNJAT NATO CBRN RBE (via JCBRN Defence COE) MNCG NATOJEWCS USEUCOM NMR of Belgium to SHAPE NMR of Bulgaria to SHAPE NMR of the Czech Republic to SHAPE NMR of Denmark to SHAPE NMR of Estonia to SHAPE NMR of France to SHAPE NMR of Germany to SHAPE NMR of Greece to SHAPE NMR of Hungary to SHAPE NMR of Latvia to SHAPE NMR of Lithuania to SHAPE NMR of The Netherlands to SHAPE NMR of North Macedonia to SHAPE NMR of Norway to SHAPE NMR of Poland to SHAPE NMR of Romania to SHAPE NMR of Slovakia to SHAPE NMR of Turkey to SHAPE NMR of the United Kingdom to SHAPE NMR of the United States to SHAPE PNMR of FINLAND to SHAPE PNMR of SWEDEN to SHAPE

Information:

Internal:

Action:

JFCNP Distr List ALL DIRECTORATES JFCNP Distr List ALL ADVISERS JFCNP Distr List ALL DIVISIONS JLSGNP

Information:

JFCNP Distr List CG OFFICES

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ANNEXA TO JFCNP/PLANS/J7/AK/21-04546 DATED ~'3:,JUL 2021

ANNEX A: Personnel Attendance Allocations and Working Routines for ST JU22 CPTM2

Ser Organisation Max No of Physical Remarks (a) (b) Attendees (d)

(c) 1 SHAPE 4 2 JFCNP 10 Inc Syndicate leads 3 JWC 6 4 AIRCOM 5 Inc NCS JFAC and CFSpCC 5 MARCOM 3 6 LANDCOM 4 7 CyOC 2 8 JFCBS 3 9 NSHO 3 TSC 10 SJLSG 3 11 JSEC 3 12 SFN 3 13 JLSGNP 2 14 1GNC 3 15 TURMARFOR 3 16 DEU SOCC 3 17 DEU CJ CBRND- TF HO 2 Inc CBRN JAT 18 NATO CBRN RBE 2 19 MNCG 3 20 NSPA 1 21 NCISG 1 22 NCIA 1 23 NA TO Nations 18 24 FI N National Rep 1 25 SWE National Rep 1

Margin 0

TOTAL: 90

1. The above allocations are necessary to impose to maintain a manageable, CaVID safe meeting. Additional applicants will not be accepted without prior agreement of the ST JU22 aCE aPR, should places not be taken up by other stakeholders.

2. A very high level programme to set out working practices for the conference is below: a detailed agenda sufficient to inform preparatory actions beyond the administration necessary for attendance will be issued in due course:

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Mon 13 Sep 21 Tue 14 Jun 21 Wed 15 Jun 21 Thu 16 Jun 21 Registration

0900-1000 0900-0930 VTC Comms Syndicate Sessions Syndicate Sessions Syndicate Sessions

0930 Opening Remarks

1000-1200 Plenary Session Syndicate Sessions Syndicate Sessions Syndicate Sessions

1300-1430 Syndicate Sessions Syndicate Sessions Syndicate Sessions Syndicate Backbriefs

1430-1600 Syndicate Sessions Syndicate Sessions Syndicate Sessions Plenary Review and Actions

1600-1645 KOPR End of Day KOPR End of Day KOPR End of Day CPTM Close Review Review Review

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ANNEX B TO JFCNP/PLANS/J7/AK/21-04546 DATED ..l.~JUL 2021

ANNEX B: JFTC Administrative and Event Registration Instructions for ST JU22 CPTM2

1. Registration. JFTC requests attendees to create User Accounts and complete the electronic registration form with all required data at https://events.jftc.nato.int. The registration should be completed as soon as possible, but NL T 23 Aug 2021. If not all requested information is available at the time of registration, it can be updated later.

2. In-Processing and Costs. The in-processing will be conducted upon arrival at JFTC on 12 (Sunday 1500 - 1830) and 13 Sep (Monday morning). Optional lunch is available at a cost of 24 PLN (about 6 EUR) per day. There is a mandatory administration fee of 12 PLN (about 2.8 EUR) per day. All payments will be made individually during in-processing only with major credit cards (American Express not accepted).

3. Accommodation. Due to the COVID-19 considerations, all attendees have to be accommodated in local hotels appointed by JFTC. Rooms can only be booked through JFTC Protocol and Conference Support POC1 on a first come, first served principle. If a room in the requested hotel is not available, the requestor will be informed. Once successfully registered, attendees will receive an e-mail with admin instructions and a reservation number. Confirmation of the reservation and payment are an individual responsibility and must be done in PLN via credit card. If the individual fails to confirm the room by 05 Sep 2021, the booking will be cancelled. The following hotels are available:

a. Mercure Hotel (****) 348 PLN (approx. 78 EUR) per night, including breakfast, Wi- Fi and VAT. Parking is available at 55 PLN (approx. 13 EUR) per day.

b. Stoneczny Mtyn (****) 335 PLN (approx. 75 EUR) per night, including breakfast, Wi-Fi and VAT. Parking is available at 40 PLN (approx. 9 EUR) per day.

c. Holiday Inn Hotel (****) 338 PLN (approx. 76 EUR) per night, including breakfast, Wi-Fi and VAT. Parking is available at 35 PLN (approx. 8 EUR) per day.

4. Transportation. Transportation from and to the Bydgoszcz Airport and train station to JFTC/hotel depends on availability. Daily transportation to and from the hotels to JFTC will be provided. Attendees using other airports are responsible for arranging their own travel to Bydgoszcz. Further details on how to get to Bydgoszcz are available on the JFTC website under 'Organization/ How to get to JFTC'.

5. Location. The Steadfast Jupiter 22 Core Planing Team Meeting-2 (ST JU22 CPTM-2) will be held from 13 - 16 Sep 21, in building 5 of the Joint Force Training Centre (JFTC), located at ul. Szubinska 2. 85 - 915 Bydgoszcz, Poland.

6. Security. A valid proof of NATO Personnel Security Clearance (PSC) at the level of NATO SECRET or above is required to gain access to training area (Security Class II Area) as well as to have access to classified documents and/or CIS. The above requirement applies to external personnel who are staff members of a NATO military or civilian body, a national

1 Details in the covering letter

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military or civilian body of a NATO Nation or contractors who are nationals of a NATO Nation. The NATO Personnel Security Clearance Certificate can be sent via email to [email protected] or uploaded as electronic version during the event registration NL T 23 Aug 2021.

Type of access Description Criteria Unescorted Unescorted access to Security One of the following must be access Class II Area. presented on the in-

Access to NATO CIS. processing day: May have access to NATO A valid NATO Personnel classified information up to Security Clearance Certificate NATO SECRET level. (NATO SECRET level), or

Attestation of NA TO Personnel Security Clearance (NATO SECRET Level), or A valid NATO AMIS Card (NATO SECRET Level)

Escorted access Escorted access to Security No proof of NATO Personnel Class II Area. Security Clearance. No access to NATO CIS. Invalid NATO Personnel No access to NA TO classified Security Clearance information. Certificate.

7. Personal Electronic Devices. Hand carried baggage will be subject to search. Mobile phones, smart watches, fit bands, photographic and video equipment are not allowed into a Security Class II Area and must be stored in the lockers in the lobby. Duty laptops and storage media (USB sticks, hard drives, etc.) to be used during the event will be checked and registered by Communications and Information Systems (CIS) Security during the in­ processing.

8. Transfer of Briefings/Documentation. In line with security regulations, files to be used during the meeting can be uploaded by the JFTC Central Registry (CR) once the relevant storage medium has been registered/checked by JFTC CIS Security.

9. Status of Forces Agreement. Under Article 3 of the NATO Status of Forces Agreement (SOFA), military personnel are not required to obtain a visa to enter Poland while travelling on official business provided that they possess a travel order and their national identification cards. Although not required under NATO SOFA, it is recommended that military personnel also bring their passports.

10. Dress Code. The dress code during the event will be national daily duty uniform or civilian equivalent.

11. Duty Free Shop. A duty free shop is available for entitled personnel at the JFTC Compound. Ration cards will be issued to entitled personnel during the in-processing. In order to receive the ration card attendees can upload a copy of a national or NATO Travel Order during registration.

12. COVID-19 related restrictions. Due to the present COVID-19 situation JFTC has seen a significant reduction in preventive measures - specific details can be found at Annex C to this

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letter and on the event registration page. As the situation changes constantly participants have to be prepared that they may be reinstated, even on short notice.

JFTC may also arrange testing for those who need to present a negative test result after the meeting and prior to their departure. This test, however, will have to be declared and paid for individually.

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ANNEX C TO JFCNP/PLANS/J7/AK/21-04546 DATED !i3 JUL 2021

ANNEX C: JFTC COVID-19 PRECAUTIONARY MEASURES FOR VISITORSI EVENT PARTICIPANTS

1. JFTC considers the safety of visitors, staff and their families a priority, and as such all necessary measures to prevent the spread of COVID-19 will be taken. The measures employed both prior to and during your stay at JFTC should give you confidence that your safety is of paramount importance to the Commander and his staff, but our area of operation is limited to the JFTC compound. We therefore strongly encourage you to apply sensible precautions whilst staying in Bydgoszcz and avoid situations where you might be more exposed to the virus. This will help safeguard the integrity of JFTC and prevent disruption to the event you are attending.

2. Before traveling to JFTC you must review your national and State of departure COVID-19 travelling regulations, as well as the regulations for travel into Poland - these may change frequently. The newest polish regulations can be found under www.gov.pl/web/coronavirus. Visitors with non NATO status crossing the Polish border from outside of the EU and the UK should consult with the Polish Embassy before arrival to check the most current travel restrictions applicable to them as they may not be granted entry into Poland. Should you have any questions regarding entry requirements into JFTC please contact JFTC as soon as possible [email protected] (Protocol and Conference Support POC; tel: +48.261.411.482 or +48.605.735.928).

3. You are required to complete the following actions:

a. Obtain a certificate from your doctor confirming you display no COVID-19 symptoms (Appendix 1).

b. Complete the Epidemiological Questionnaire (Appendix 2). If the epidemiological data indicates suspicion of a possible COVID-19 virus transmission or infection threat, you may be required to quarantine for a ten-day period after arrival.

c. Submit the doctor's certificate (Appendix 1) and the Epidemiological Questionnaire (Appendix 2) via unclassified e-mail [email protected] (Host Nation Support Central Point of Contact) no later than five days prior to your arrival in Poland.

d. If you develop COVID-19 symptoms and are tested positive within 10 days after your departure from JFTC, complete the COVID-19 Declaration (Appendix 3) and send it to [email protected] (Protocol and Conference Support POC).

4. The following measures will be implemented regardless of your country of origin, method of travel, or length of stay.

a. Social distancing is to be observed at all time. Congested areas are to be avoided.

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b. Provided disinfectants for hands (entrances of buildings) are to be used.

c. You are required to wear a facemask (covering your mouth and nose) at all times while travelling by JFTC provided transportation. Face shields are not any authorized substitute. d. Please arrive at JFTC with a sufficient number of facemasks to last for the duration of your time at the Centre. Hand sanitiser will be available at key areas within JFTC and public areas.

e. Should you display COVID-19 symptoms, you will be required to isolate from others to mitigate possible spread of the virus. You will then be requested to contact the Protocol and Conference Support POC (available 24/7) to receive further guidance based on consultation with a doctor.

f. JFTC is not responsible for any expenses that are likely to result from being in isolation or quarantine.

g. If you fall sick, JFTC, through the Host Nation Support Unit, will provide support until your national chain of command is able to take over.

h. Bring contact details of your parent unit with you so that you can contact them in the event of you becoming involved in a COVID-19 related incident.

5. Your Point of Contact (POC) in the event you experience COVID-19 symptoms while at JFTC is [email protected] (Protocol and Conference Support POC). She can be reached via mobile phone at +48.605.735.928 (24/7).

APPENDICES:

1. Format for Doctor's Certificate 2. Epidemiological Questionnaire 3. Participant's COVID-19 Positive Result Declaration

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APPENDIX 1 TO ANNEX C TO JFCNP/PLANS/J7/AK/21-04546 DATED JUL 2021

DOCTOR'S CERTIFICATE

I certify that. . presents no recent history of complaints such as fever, dry cough, shortness of breath, or sudden loss of smell or taste within the last 14 days and that, on current examination, shows no symptoms of COVID-19 infection.

Date and place Doctor's signature

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APPENDIX 2 TO ANNEXCTO JFCNP/PLANS/J7/AK/21-04546 DATED !20 JUL 2021

Epidemiological questionnaire for military personnel (soldiers, civilian personnel, contractors) arriving from countries affected by the COVID-19 Outbreak.

1. Rank, name, surname

2. National personal number/DoD ID#

3. Date of birth (DD/MM/YYYY)

4. Address (in Poland), unit, phone number:

5. Where have you been within last 14 days? (China, South Korea, Iran, Italy, others).:

I.p. Location (country) Time Remarks

6. Type of service (i.e. medical personnel, civil-military cooperation etc.)

7. Have you (or you family member or colleague) been in contact within last 14 days with person having probable or confirmed COVID-19 case (date of last(DD/MM) contact, circumstances etc

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8. Do you have or did you have any of the following symptoms? (if yes please indicate thedate of onset)

1) fever (above 38°C/100,4 F)

2) cough

3) shortness of breath

4) sore throat

5) acute respiratory distress syndrome

6) loss of smell and taste

9. Other signs and symptoms:

10. Have you been tested for the presence of coronavirus

• PCR test

No DYes D Date of test (DD/MMIYYYY): .

Result: negative D positive D • antigen test

No DYes D Date of test (DD/MMIYYYY): .

Result: negative D positive D • serological test

No DYes D Date of test (DD/MMIYYYY): .

Result: negative D positive D

11. Hospitalisation:

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Have you been hospitalised due to COVID-19 disease suspicion?

If yes: Hospital Country, town

Date of Admission

Isolation-from to

Intensive care unit: No DYes D

12. Quarantine:

No D Yes D (DD/MMIYYYY) from to

13. COVID-19 Vaccination

No DYes D vaccine producer

First dose(DD/MMfYYYV) Second dose(DD/MMfYYYY)

14. Other important information:

(date) (rank, signature)

Developed by The Chief of the Sanitary Inspection- The Department of the Military Medical Service

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APPENDIX 3 TO ANNEX C TO JFCNP/PLANS/J7/AK/21-04546 DATED ~~ JUL 2021

Participant's COVID-19 Positive Result Declaration

1. 1 (name), representing

....................................................................................... (your current organisation)

inform that I have tested positive for COVID-19 on (date).

2. I departed JFTC on (date and time).

3. When I attended the JFTC event, I stayed at (name of the hotel).

4. During my stay in Bydgoszcz, I began to exhibit the following symptoms:

temperature above 38 degrees, cough, shortness of breath, lethargy, loss of smell, loss of taste, none (Circle each that applies).

5. I can be reached via telephone at or via email at:

Signature _

Date: -----------

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