Veterinary Health Care Team of Arizona

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Registration forms for VHCTAz continuing education programs

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Fax registration with credit card information to AzVMA 602.249.3828
or mail with check to: AzVMA, 
100 W. Coolidge St., Phoenix, AZ 85013
Questions? Call AzVMA at 602.242.7936

CVT Study Group/PHOENIX: Spring 2010
Registration Includes Study Booklet

VHCTAz member: $150
  Non-member (includes 1 year optional membership): $186

You MUST indicate one of the following locations:

____ East Valley Location

____ Phoenix Location

___ I prefer to waive the 1 year membership for VHCTAz and pay the non-member registration fee.
Name:
Hospital:
Phone:                                                                  Fax:
Email:
Visa, MC, Discover, AMEX #:                                                
Exp. Date:                                                            Amount: 
V-code:
Credit card billing address zip code:
Credit card holder's name:
Signature:

See above for fax number or address.

CVT Study Group/TUCSON: Spring 2010
Registration Includes Study Booklet

VHCTAz member: $150
  Non-member (includes 1 year optional membership): $186

___ I prefer to waive the 1 year membership for VHCTAz and pay the non-member registration fee.
Name:
Hospital:
Phone:                                                                  Fax:
Email:
Visa, MC, Discover, AMEX #:                                                
Exp. Date:                                                            Amount: 
V-code:
Credit card billing address zip code:
Credit card holder's name:
Signature:

See above for fax number or address.

Your Brush with Success: 3/11/10
VHCTAz member: $65
  Non-member (includes 1 year optional membership): $101

____ Please indicate if a vegetarian meal is required.

___ I prefer to waive the 1 year membership for VHCTAz and pay the non-member registration fee.
Name:
Hospital:
Phone:                                                                  Fax:
Email:
Visa, MC, Discover, AMEX #:                                                
Exp. Date:                                                            Amount: 
V-code:
Credit card billing address zip code:
Credit card holder's name:
Signature:

See above for fax number or address.

Valley Fever: 3/18/10
VHCTAz member: $65
  Non-member (includes 1 year optional membership): $101

____ Please indicate if a vegetarian meal is required.

___ I prefer to waive the 1 year membership for VHCTAz and pay the non-member registration fee.
Name:
Hospital:
Phone:                                                                  Fax:
Email:
Visa, MC, Discover, AMEX #:                                                
Exp. Date:                                                            Amount: 
V-code:
Credit card billing address zip code:
Credit card holder's name:
Signature:

See above for fax number or address.