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test results are sent on-time or the next kit is FREE

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Register Kit

Please fill out the form below so that we can register your test kit.

Please indicate place of purchase:

Please choose kit identification:

Sample Collection Date:

Sample Collection Time:
:

Sample Location (sink, outdoor faucet, etc.):

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Email Address:

Phone Number: