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History Please answer the following questionst Have you ever been hospitalized or had major operation? Do you use tobacco? C) No Do you take, or have you taken? Phen-Fen C) No C) No

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Page 1: History Please answer the following questionst Have you ever been hospitalized or had major operation? Do you use tobacco? C) No Do you take, or have you taken? Phen-Fen C) No C) No
Page 2: History Please answer the following questionst Have you ever been hospitalized or had major operation? Do you use tobacco? C) No Do you take, or have you taken? Phen-Fen C) No C) No

GENERAL & PRODUCTS LIABILITY APPLICATION...high power sub ohm devices? Yes No c) Are you a member of AEMSA? Yes No d) i. If the products you sell are not manufactured by you – please

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