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2013 MVMA Fall Conference

6 Hours Continuing Education

Registration Form

Fill out the form below to register for the seminar. If you prefer to register by fax or mail, click here to download a form to print.

 

REGISTRATION FEES

Before 10/3

After 10/3

 

Veterinarians

$220

$245

 

MVMA Life Members & Retired Members

$160

$185

 

Veterinary Technicians

$160

$185

 

Students of Veterinary Colleges

$115

$115

REGISTRATION SELECTIONS: (List all attendees)

Note: You must select an attendee type (DVM, RVT, etc.) for each registrant.

First Registrant

Name Nickname           $

VMD   DVM   Technician   RVT    Student 

Membership Status   


Second Registrant

Name Nickname           $

VMD   DVM   Technician RVT    Student 

Membership Status   


Third Registrant

Name Nickname           $

VMD   DVM     Technician  RVT   Student

Membership Status   


                                                                     $


PAYMENT INFORMATION

Practice Name

Address 

City

   State     Zip

Work Phone

 

Email

 Please charge $  to my:

  VISA   MasterCard   American Express

Card Number Exp. Date  

CSC No. (required)   (What's this?)

Cardholder name

Billing Address (required, no PO boxes) 

City  State    Zip (required) 

IMPORTANT: If you have a disability or dietary need and require special accommodation in order to fully participate in this event, please include a written description below. We can only provide assistance if we have prior notice.

       

 

 

 


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2014 Maryland Veterinary Medical Association

Maryland Veterinary Medical Association l PO Box 5407 l Annapolis, MD 21403
phone: 410-268-1311 l fax: 410-268-1322

e-mail: MVMA@KeyAssnMgt.com