First Name
*
Last Name
*
Clinic Name
Phone
*
Email
*
What Chiropractic school did you attend?
What techniques do you use in your practice?
Do you use any adjusting instruments in your practice?
If yes, Which instrument (s):
I hereby give my consent for demonstration at the association convention. I understand that the purpose of this demonstration is to showcase the functionality and capabilities of this device. I release and hold harmless the organizers, presenters, representatives, the ProAdjuster Group and the association from any and all liability, claims, demands, or actions that may arise from my participation in the ProAdjuster demonstration, including but not limited to any personal injury, loss, or damage that may occur. By signing below, I confirm that I have read and understood this consent form in its entirety and that I voluntarily consent to participate in the ProAdjuster demonstration at the association convention.
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