From Aaron Bolinger, Legislative Director, National Veterans Committee on Constitutional Affairs and Legislative Director & Mid-Atlantic Regional Coordinator, Restore The Republic Network:

Below is the link to a 4 page document. (This is one of the little devices that cause ulcers in the guts of our overlords. Nothing like using an “ulcer device” on socialized medical providers ~wink~)

Before YOU or YOUR CHILD receives any vaccinations, whether “required” by the school system or otherwise, you should REQUIRE the physician to sign THIS BABY! If they won’t sign it, and identify the toxins they are injecting, then why should you take the needle? Distribute far and wide, post on the blogs, hand to state legislators and ask that they assist in distribution to their districts, etc. This will help those opposed to vaccines on “religious liberties” grounds, and pretty much anyone who objects for whatever reason. If this starts popping up by the tens of thousands, it will cause a massive retreat of the pharmaceutical giants pushing the poisons. At worst, it will seriously slow down the lines in the “clinics.”

www.davidicke.com/images/vaccineform.doc