17 



(Application Card) 



MASSACHUSETTS AGRICUI/rURAL EXPERIMENT STATION 



DKPARTMKNT OF VKTKRINARY SCIENCE 

 APPLICATION FOR AGGLUTINATION TEST ON DOMESTIC FOWL 

 Name Tel. No. Date 



P.O. Address 



Express Address County 



Month Test is desired Total birds in flock 



l)reed and nuiiiher of ) Hens Pullets Males 



each to l^e tested: ) 



Do you desire a retest? 



Siiall your report l)e aixen to tiie County Extension Ser\ice? 



The Treasurer of the College will not permit additional testing until your 



account is paid. 



I promise to pay for service rendered at the rate of 10 cents for each 



bird tested and 1 cent for each leg band furnished, within 30 days after 



receipt of bill. 



Signed (over) 



