Assignment Release for Vita Royal Clinical Trial
All participants in must complete and sign the following form. Please print it out and fax it at (605) 787-4178 or mail it back to us at 840 Husker Pl. Rapid City SD, 57701.
Assignment
In consideration of value received in supplements and treatment,
I, _________________________________________
Street Address, ___________________________________________
City, State, Zip __________________________________________,
Home Phone _____________________ Work __________________
hereafter referred to as "Assignor," sells and assigns to Ms.Linsey McLean, 4267 S. State Road, Davison, MI 48423, her successors, assigns or nominees, hereinafter referred to a "Assignee," the entire right, title and interest in video footage, photographs, lab tests, reports and all related information including veterinary exams in which Assignor or Assignor's horse appears as part of a study of Assignee's methods for treating horses and grants to said Assignee permission to use said video footage in any manner not offensive to the ordinary person.
Subscribed and executed at: City, State _______________________________
Date __________________ Assignor ______________________________________
Would you like us to use your name and your horse's name? Yes __ No __
If you need a copy of our Equine Case History Questionaire <-- click here.
© 2007 Vita Royal Products Inc.
