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ASG Report
Name
(Required)
First
Last
Email
(Required)
Reporting Period
(Required)
MM slash DD slash YYYY
Region
(Required)
Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7
Region 8
Region 9
Region 10
Region 11
Region 12
Region 13
Region 15
Region 16
Region 17
Region 18
Region 19
Region 20
Detail any Medical related activities within your Region during the reporting period
(Required)
Regional Medical ASG Facebook Page Members
(Required)
Were you able to post on the Fleet Medical Facebook page on your Region's day?
(Required)
Yes
No
What was the topic of your Fleet Medical Post(s)?
(Required)
