Name* First Last PhoneEmail* Are you willing to speak with local media?*YesNoYou are?*MilitaryCivilianYour Story*Please describe your experiences related to MefloquineMay we include your story online?*We are compiling testimonials and experiences related to Mefloquine use. Yes Yes, but do not include my name No, please keep my story private Upload a PhotoIf you are comfortable doing so, please upload an appropriate profile Image.Accepted file types: jpg, jpeg, png, gif, pdf.NameThis field is for validation purposes and should be left unchanged.