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Health Declaration

Please fill out the following form
in order to participate in our activity.

Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?

Thanks for submitting!

Main Line: (512) 580-3856

Fax Line:   (512) 580-3848

Directory:  (512) 580-3721

3200 Steck Avenue

Suite 250

Austin, Texas 78757

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