Registration
Form
ContinuEd presents... Common Behavior Problems in Pets
September 14, 2008 • Hilton Garden Inn Boston - Burlington • Boston (Burlington), Massachusetts
Registration deadline for lower fees: Friday, August 15, 2008. Final deadline: Friday, September 5, 2008.
| How to register | ||
| Online: Click here to register online now. This will take you to a secure server, where you can register using your Visa, MasterCard or American Express card. |
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| By mail: Print, complete, and mail this form, with a check enclosed or credit authorization, to:
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By FAX: Print, complete, and FAX this form with credit authorization, to: (206) 230-8359 |
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| Questions?: Call ContinuEd at 1-800-539-7395 (Office hours: 9am to 4pm, Pacific Time, Monday through Friday. Voice mail anytime.) | ||
Name(s) - PRINT CLEARLY-
Name will appear on certificates as written below.
Circle your title (DVM, RVT, etc.), or enter it in the blank, where appropriate.
If you desire a nickname on your name tag, print it in
the blank after your name.
1) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
2) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
3) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
4) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
5) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
6) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
7) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
8) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
9) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
10) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
11) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
12) __________________________________________ RVT CVT LVT AHT DVM VMD Other: _____ Nickname: ___________
Hospital Name:
_______________________________________________
Mailing Address: _____________________________________________
City: _____________________________ State/Province: ____________
Zip/Postal Code: ______________ Country: ________________
Day Phone: (____)______ - _________ FAX: (____) ______ - _________
E-mail address: ________@___________
| ____ registrant(s) | REGISTRATION FEES (these fees are avaiable until Friday, August 15, 2008) 1 to 3 registrants @ $179 per registrant 4 or 5 registrants @ $169 per registrant 6 or more registrants @ $159 per registrant 12 or more registrants @ $149 per registrant |
= $ ________ |
| ____ registrant(s) | LATE REGISTRATION FEES (after Friday, August 15, 2008) 1 to 3 registrants @ $194 per registrant 4 or 5 registrants @ $184 per registrant 6 or more registrants @ $174 per registrant 12 or more registrants @ $164 per registrant |
= $ ________ |
| TOTAL | = $ ________ | |
| We do not "hold" places based on a phone call or a fax indicating that you are mailing a check. Registrations are accepted only with payment. Registrations must come together for the multiple-registrant discount to apply (same form or phone call). Fees for additions at a later date are based on the total number on NEW additions only, independent of the number you may have registered at an earlier date. | ||
Payment method (check
one):
( ) Check (enclosed, payable to ContinuEd)
( ) Visa ( ) MasterCard ( ) American Express
Acct. #: _________/_________/_________/__________ Exp. _________
Cardholder: __________________________________________________
Signature: ____________________________________________________
Address where bankcard statement is received (for bank verification purposes):
_____________________________________________________________