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It takes brave people like you standing up who make a difference and affect change.  Your information can help your co-workers and people all across our industry.  Thank you for your willingness and bravery.  Our promise to you is the utmost in discretion with your information.  Upon completion of this form, our confidential researcher will reach out to learn more.  Your identifiable information will NEVER be shared without your permission.  Only de-identified information may be reported.  Again, thank you for your help and support.  We are here for you.  At any time, you may contact:   vaxharm@ae4hf.org