Burglary or fire at the residence of the attendee in the forty-eight (48) hours immediately before this event that required attendance of the emergency services.

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1. Contact Information (Required.)

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2. Name of Registration Purchaser (Required.)

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3. Registration Price Paid (in USD) (Required.)

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4. Registration Number (Required.)

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5. Date Purchased (Required.)

Date

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6. When did you become aware that you would not be able to attend the Event Please provide all details. (Required.)

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7. Please be advised we require evidence from emergency services (such as a Police Report) or a letter from your insurance company that you suffered a fire or burglary within 48 hours prior to the event commencement. Upload the required documents below. (Required.)

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8. Date of Incident (Required.)

Date

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9. Details of Incident (Required.)

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10. Details regarding the circumstances of why you were not able to attend. (Required.)

T