DB Di Benedetto Srl

SPACE

EquiTech 99

Registration Form

The event will take place in Rome (Italy) in March 20-21, 1999.
Full meeting fee is US$ 460,00. Details in More Information

Please, register me to:	*EquiTech 99*
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
COUNTRY:
PHONE:
FAX:
E-MAIL ADDRESS:

PLEASE CHECK ONE OF THE FOLLOWING:

	DVM	FARRIER
	OWNER	STUDENT
	TRAINER
	OTHER (Please indicate):

	I am fully aware this convention has hazardous activity. In consideration for the right to partecipate I hereby waive any and all rights or claims I may have as a results of participation in the EQUIFORUM 99 convention against the Di Benedetto Srl, its president, manager, officers, employees, agents and all individuals assisting in instructing, participating and conducting activities, and I hereby fully release and discharge them from any and all claims resulting from injuries, including death, damages or loss, which may accrue to me or my heirs arising out of or in any way connected with my participation in the EQUIFORUM 99 convention. I acknowledge and represent I have read and fully understand this release and waiver of claims, and that, if I had any questions or issues about it, I have asked those questions and I have been provided with full complete information which was fully responsive.

	SPACESPACE