Name *

First Name

Last Name

Phone *

(###)

###

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I understand that I will be visiting a site that is under continuous scientific monitoring, and therefore, my actions on-site must adhere to policies provided *

Yes

No

I understand that my failure to adhere to site policies will result in my dismissal, and that any financial losses as a result of my trip being cut short are not the responsibility of The Provenance Company *

Yes

No

Liability Form *

I have read the attached liability form

By checking this box I am signing this agreement electronically