Submit Your Photo - World Parkinson Coalition

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First Name *
Last Name *
City *
Country *
Email Address *
Description of photo
Attending WPC 2019 *	YES- I will attend the WPC 2019 MAYBE - I hope to attend the WPC 2019
Permission for use *If you give permission for the WPC to use your photo on its website, click YES. If you do not give permission for the WPC to use your photo on its website, click NO.	YES - the WPC may use my photo on its website NO - the WPC may NOT use my photo on its website
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