Warranty Registration

TO ACTIVATE THE WARRANTY PERIOD FOR THE LIFE-TECH ITEM PURCHASED, PLEASE COMPLETE AND SUBMIT THE FOLLOWING FORM:

Registration Form
*Name :
*State or Country :
*Email :
*Telephone :
*Item Model :	(e.g. Microflo II)
*Item Serial Number :	(e.g. E623R8)
Item Catalog Number :	(e.g. 2002)
Date Purchased :	(e.g. May 12, 2008)
Additional comments:

Urodynamic Options
Urodynamic Instruments:
Urodynamic Consumables:
Purchase Anticipated:

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