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Reptile Day Online Registration

For more information contact Donald Uricchio at duricchio@miamisci.org

*Required Information

Registration Form for Reptile Day  
*Owner's Name:
*Birthdate:
*Address:
*City:
*State:
*Zip Code:
*E-mail:
Species of Reptile:
Approximate Length of Reptile:

Tell us some fun and interesting facts about your reptile! (How you got him/her, favorite activity, vital stats, etc.):

How did you hear about Reptile Day?:

Museum Website    T.V.     Newspaper  

Advertisement        Friend    Pet Store

Other

What other reptiles do you own? Lizard

Turtle

Tortoise

PHOTO RELEASE STATEMENT:
"I understand photographs may be taken for marketing purposes. I give permission for pictures of me or my reptiles to be used."

WAIVER:

"The undersigned agrees that Museum of Science and Planetarium will not be held responsible for any injuries caused to either persons or animals participating in this program."
* Name
*Date
* Signature Authorization


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