District of Columbia Academy of Veterinary Medicine, Inc.
2007-2008 Technician Seminar Series Registration Form

Series registration is technician-specific and is non-transferrable. Series registration permits attendance at all 4 seminars within the seminar series. Benefits for registering for the entire series include the following:
  • Savings of more than $145.00 over the individual seminar fee if registered by September 20, 2007.
  • The DC Academy of Veterinary Medicine will archive your continuing education credits and mail you a continuing education statement at the end of the program year.
  • Receive meeting announcements by mail to your designated mailing address.
  • Have access to seminar handouts via the DC Academy website in the Technician section.
Fill out completely (please PRINT) and return with your payment. Only one person per form, please.

Name___________________________________ Cert. (LVT, RVT, other)_________________

Home Address__________________________________________________________________

City_______________________________________ State___________ Zip_____________

Hospital/Organization Name____________________________________________________

Business Address______________________________________________________________

City_______________________________________ State___________ Zip_____________

Office Phone (       )____________________   Home Phone (       )______________________

Which address do you prefer for academy mailings? (Home)_____   (Office)______

E-mail Address _____________________________________________

Graduate of Veterinary Technician Program?   Yes_____   No_____

If yes, name of school __________________________________  Year Graduated ________

STUDENT INFORMATION: Students enrolled full time in an accredited veterinary technician program are not required to pay registration fees. Please complete the following information:

Name of School____________________________   Expected Graduation Year________

Checks are made payable to: DCAVM, P.O. Box 710477, Herndon, VA 20171  Phone: 703-733-0556
Fax: 703-742-8745   Website: http://www.dcavm.org   Email: admin@dcavm.org
Your cancelled check is a valid receipt; if additional receipt is required for reimbursement, check here ____

FEES: FT Student in Accred Vet Tech Program No charge
    Early Series Registration Discount (Before Sept 20) $115
    Standard Series Registration (After Sept 20) $140
    Individual Series Registration Fee (Paid at the door) $65

If charging to VISA or MasterCard, please complete the following (on-site registration only)

Please charge my VISA____   MasterCard____   Amount____________ 3 Digit Security Code _________

Acct# __________________________________________  Exp. Date ______________

Signature _________________________ Name (please print) _______________________


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