Jnetics on Campus Student Reps form Name(Required) DrMissMrMrsMsProf.Rev. Title First Last Date of Birth(Required) DD slash MM slash YYYY Mobile(Required)Email(Required) Home Address(Required) Street Address City County / State / Region ZIP / Postal Code University Address(Required)Your address while at University. Street Address City County / State / Region Post Code University Name(Required) University ID(Required) University Course(Required) Have you been tested through Jnetics before? Yes No Where and when were you tested? Are you involved in your university JSoc?(Required) Yes No As a rep, how would you help Jnetics to raise awareness of our Jnetics on Campus – University Screening Week event and encourage students to sign-up?(Required)What is your availability to meet with a member of the Jnetics team?
