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AAEVT 2013 IVECCS Wet Lab Day Advance Registration Form This program will offer 5.5 RACE CEU.

Deadline for mailing registration forms is August 30th,2013. After this date please call or fax. Registration is limited ! Full Name: _________________________________________________________________ Designation: __________________ Street Address: _________________________________________________________ City: _____________________________ State: _______________ Country: ____________________________________________ Postal Code or Zip: _______________ Employer: _______________________________________________________________________________________________ Phone: ___________________________________________ Fax: __________________________________________________ Email: __________________________________________________________________________________________________ Member Number: ___________

Please check if you are enrolled in the On-line Certification Program: ____________

(Check one)

Member

Wet Labs Only – Limited to 20

□ $125

Non – Member

□ $200

Student

$75.00

(Includes supplies, Lunch and transportation.

Schedule: 8:30 arrive - Continental Breakfast 9-10:30 - Catheters - Stephanie Stalla, DVM 10:30 - 12 - Field Anesthesia – Maureen Kelleher, DVM, CVA, DACVS 12-1:30 Lunch and Purina presentation: Equine Nutrition 1:30 - 2:30 Acupuncture - Maureen Kelleher, DVM, CVA, DACVS 2:30 – 3:00 RLT Laser Demonstration - Ryan Corrigan, RVT ** Transportation will be provided if needed from IVECCS /Convention Center Link to SDEG: http://www.sdequine.com/index.php for Map and Directions Students: Technician program enrolled in _________________________________

* Students must bring proof of enrollment*

Payment Method: Check Enclosed: Check # _________ Amount: ______________ Credit Card: _____ Visa _____ MasterCard Card Number: _____________________________________________ Card Expiration: _____________ SEC Code #: ________ If Cardholder is different than attendee: Name on Card: _________________________________________________________ Billing Address :________________________________________________________________________________________

By registering for these Wet labs I understand the risks involved and do hereby release and hold harmless the AAEVT and the host clinic from any and all liability claims. _____________________ (Please initial) Return your Registration by Fax to 760-301-0349 or mail to: Deb Reeder, RVT 539 Wild Horse Lane San Marcos, CA 92078 Any questions, please contact Deb Reeder, RVT at (214) 505-1548 dbreeder@gmail.com. **Please use IVECCS WetLab Day in your subject line.


Iveccswetlabday2013 registration  
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