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Email Address
First Name
Last Name
ZIP Code
Horse's Name
Birth Month
Birth Year
Discipline
1
01
02
03
04
05
06
07
08
09
10
11
12
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Racing
Dressage
Hunter
Jumper
Eventing
Western Performance
Pleasure
Do you currently use Adequan
®
i.m. for your horse(s)?
Yes
No
Have you ever used Adequan
®
i.m. for your horse(s)?
Yes
No
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