KOREAN ADOPTEE MASK RECIPIENT FORM Full Name First Name Last Name Address Street Address Street Address 2 City State Zip Code

KOREAN ADOPTEE MASK RECIPIENT FORM

Full Name

First Name Last Name

Address

Street Address

Street Address 2

City

State Zip Code

E-Mail

Phone

Please include area code Adoption

Agency

(Optional)

Consulate General of the Republic of Korea requires your consent before it can collect the personal information above in order to assess your eligibility and use the information you have provided to send you the masks.

Yes, I consent to collecting and using the above information

No, I do not consent to collecting and using the above information

Please submit this form to

[email protected]