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127th Annual Summer Conference

Sponsored by the Maryland, Virginia and District of Columbia Veterinary Medical Associations

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

ID

Code

Before 6/15

After 6/15

 

Veterinarian Members of Maryland, DC, Virginia and West Virginia VMAs

Entire Conference

Monday, June 24

Tuesday, June 25

 

MF

MM

MT

 

$365

$215

$215

 

$385

$235

$235

 

Maryland Lifetime & Retired Members

Entire Conference

Monday, June 24

Tuesday, June 25

 

LF

LM

LT

 

$265

$175

$175

 

$285

$195

$195

 

Non-Members

Entire Conference

Monday, June 24

Tuesday, June 25

 

NF

NM

NT

 

$415

$240

$240

 

$435

$260

$260

 

Veterinary Technicians

Entire Conference

Monday, June 24

Tuesday, June 25

 

TF

TM

TT

 

$265

$175

$175

 

$285

$195

$195

 

Students

(Attending Veterinary College)

ST Free Free

REGISTRATION SELECTIONS: (List all attendees)

Note: You must select an attendee type (DVM, RVT, Spouse, etc.) for each registrant. You must also select an ID Code for each registrant who is not a spouse or child. See chart above for appropriate ID Codes.

Name Nickname ID Code $

VMD   DVM   Retired   RVT   Technician Retired Spouse/Guest  Student

Vegetarian Meals   Kosher Meals  Special Assistance Required (describe below)


Name Nickname ID Code $

VMD   DVM   Retired   RVT   Technician Retired Spouse/Guest  Student

Vegetarian Meals   Kosher Meals  Special Assistance Required (describe below)


Name Nickname ID Code $

VMD   DVM   Retired   RVT   Technician Retired Spouse/Guest  Student

Vegetarian Meals   Kosher Meals  Special Assistance Required (describe below)


Name Nickname ID Code $

VMD   DVM   Retired   RVT   Technician Retired Spouse/Guest  Student

Vegetarian Meals   Kosher Meals  Special Assistance Required (describe below)


Name Nickname ID Code $

VMD   DVM   Retired   RVT   Technician Retired Spouse/Guest  Student 

Vegetarian Meals   Kosher Meals  Special Assistance Required (describe below)

                                                     $


SPECIAL TICKETED FUNCTION

Monday Evening Seafood Buffet - Phillips Seafood Restaurant
6:30 p.m. to 8:30 p.m.

 

 

  Quantity  
 

Adult

$36 x

$

 

Child (10-12)

$16 x

$

 

Child (5-9)

$13 x

$

 

Child (under 5)

Free

$

 

 

$

 

SPEAKER NOTES:

Web access to all speaker notes is included in your registration fee. You may purchase a printed version for $30.

 Speaker Notes - $40 x =

$

Subtotal from from registration section

$

$

PAYMENT INFORMATION

Practice Name

Address

City    State     Zip

Work Phone   Fax   Home Phone

Please charge $ to my:  VISA   MasterCard   American Express

Card Number Exp. Date   CSC # What's this?

Cardholder name

Billing Address

City

   State     Zip

If you have a disability or dietary need and require special accommodation in order to fully participate in this event, please check the box on the left. Include a description of your needs in the box below. We can only provide access if we have prior notice.

NO REFUNDS AFTER JUNE 15, 2013

       

 

 


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2013 Maryland Veterinary Medical Association

Maryland Veterinary Medical Association l 3230 Maiden Lane l Suite 5 l Annapolis, MD 21403
phone: 410-268-1311 l fax: 410-268-1322

e-mail: MVMA@KeyAssnMgt.com