Las Vegas Form

Las Vegas

  • LAS VEGAS 2017

    DECEMBER 12th-16th, 2017

    Deadline to Submit/Change/Cancel Travel Info: August 15th, 2017


    Submit by June 30th to be eligible for a $500 cash drawing in Las Vegas!

  • Fedex Delivery Address (No PO Boxes)


    *** Drivers License Information***

    *** Drivers License Information***

  • Is there a special event you will be celebrating during this trip (birthday, anniversary, etc.)?
    If so, on what date?
  • In consideration of our participation in the above-described trip, we do hereby release and forever discharge Preferred Pump & Equipment, its agents and employees from any and all claims, demands and causes of action which the undersigned now has or which the undersigned’s heirs executors, administrators, assigns or successors may have arising out of any activity in connection with the customer trip, commencing and ending on or about the dates shown above. We agree to hold harmless Preferred Pump, its directors, officers, members, agents and their heirs, executors, administrators and assigns, of and from all of the liabilities described above, arising out of or connected with our participation in said trip.
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