Registration Form
ContinuEd presents… Surgical Nursing Care in Small Animals
October 12, 2008 • Hilton Norfolk Airport • Norfolk, Virginia

Deadlines for registration: For early fees: Register by Friday, September 12, 2008.
Final registration deadline: All registrations must be RECEIVED by Friday, October 3, 2008.

How to register …
Online: Click here to register online now. This will take you to a secure server where you can register with a Visa, Mastercard, or American Express.
By phone:
 Call the office of ContinuEd at 1-800-539-7395 (9 AM to 4 PM, Pacific Time, M - F)
By mail:
Print, complete, and mail this form, with a check enclosed or credit authorization, to:

ContinuEd
Post Office Box 75598
Seattle WA 98175-0598
USA
By FAX:
Print, complete, and FAX this form
with credit authorization, to:

(206) 230-8359

Name(s) - PRINT CLEARLY- Name will appear on certificates as written below.
Circle your title (RVT, etc.), or enter it in the blank, where appropriate.
You do not need to be a licensed technician to attend this seminar. Veterinarians are also welcome to register with their staff.
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: ___________

Hospital Name: _______________________________________________

Mailing Address: _____________________________________________

City: _____________________________ State/Province: ____________

Zip/Postal Code: ______________ Country: ________________

Day Phone: (____)______ - _________ FAX: (____) ______ - _________

E-mail address: ________@___________

____ registrant(s) EARLY REGISTRATION FEES (by Friday, September 12, 2008)
1 to 3 registrants @ $169 per registrant
4 or 5 registrants @ $159 per registrant
6 or more registrants @ $149 per registrant
 = $ ________
____ registrant(s)

LATE REGISTRATION FEES (after Friday, September 12, 2008)
1 to 3 registrants @ $184 per registrant
4 or 5 registrants @ $174 per registrant
6 or more registrants @ $164 per registrant
FINAL DEADLINE: Friday, October 3, 2008

 = $ ________
TOTAL = $ ________
We do not "hold" places based on a phone call or a fax that says 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, and are priced at the rate applicable at the time of registration. They are considered NEW registrations, and are not added to the original number of registrants.

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):

_____________________________________________________________