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The Mid-Atlantic States Association of Avian Veterinarians

Up Veterinarian Registration Technician Registration Student Registration Forms to Print

- - - - Fill out the form below online or download a printable form to mail or fax - - - -

Veterinarian and Student Registration Form

Printable forms are available to print and mail by clicking the "Forms to Print" button above.

General Session - 10-12 April 2011

Includes Proceedings (CD), any Lecture, Reception,
Exhibitors Gallery and Monday Luncheon
The General Session is available only as a 3 day package. Individual reduced fee days are not available.

General Session is 17 Continuing Education Contact Hours

Laboratories provide additional hours. See each lab below.

Do not use this form to register for any single day session!

Membership Information
Title:  Dr, Mr, Ms
First Name
Last Name
Diplomate Certification
Mailing Address
City
State
Zip Code + 4
Country
Email Address   Required so we can confirm your registration. Your email address is never listed anywhere or given outside of MASAAV.
Home Phone Numbers only. No space, paren, dash, comma or period. Never published but used only if a problem develops with your registration.

Veterinary Practice or Educational Affiliation Information
Practice Name
Practice Town
Practice State
Practice Zip Code
Work Phone Numbers only. No space, paren, dash, comma or period
Fax Numbers only. No space, paren, dash, comma or period
Website This should be of the format www.yourwebsite.com. It is not your email address.

MASAAV publishes a member veterinarians list on the Internet;
 http://masaav.org/mbrsearch.htm
member veterinarians are listed unless otherwise requested.

Only the member veterinarian's name, practice name, practice city, state, zip code and website plus work phone  and fax number are listed in this directory.

Do not include me in the MASAAV directory online or if requested by clients.   

General Session Registration
Registration Category
Click on the drop-down-list arrow (downward pointing arrow at right end of the box to the right) and choose the appropriate category.
Select
Veterinarian, Resident, Intern,
Veterinary Student, Technician Student
Executive Board Volunteer? Check for yes      Can you serve on committees or the Executive Board?
Executive Board Meeting? Check for yes     Can you attend the Executive Board Meeting Saturday (the night before the conference begins) at 8:00 PM?
Current Membership?
Application Form		 Check for yes     Did you renew membership before 1 March 2011?
                     Pay non-member fee in next block, if you did not check yes.
Non-Member Fee $100 $ Due for all non-members - not applicable to students (they must pay membership)
General Session Fee

 

 $100 Refundable deposit  Student - Veterinary or Technician
$200   Intern/Resident
$350   Veterinarian
$ Enter the amount that corresponds to your category
Luncheon Guests on Monday
Vegetarian selections provided.		   Enter the total number of guests you will bring
Guest Luncheon $28 $ Enter the total amount due, $28 for each guest

Wet Lab Registration
Basic Avian Techniques Lab
- Sunday  $150 - 3 hours		 $ Enter the amount due, $150 if you take this wet lab.
Emergency Techniques Lab for Small Exotic Mammals Lab - Sunday  $150 - 4 hours $ Enter the amount due, $150 if you take this wet lab.
Advanced Avian Techniques Lab - Monday  $150 - 3 hours $ Enter the amount due, $150 if you take this wet lab.
Conference Proceedings One CD copy of 2011 proceedings is included with registration. 
Printed Proceedings $55

Printed copies of the proceedings must be ordered.
CD copy is included with printed copy.

 Printed proceedings are available for years 1985 through 2011. Click for contents list.
$   Enter the amount due, $55 for each copy.

Total Due --->  

$   Enter the amount of money due.

Partial refunds, less 25%, can be made until 14 March 2011. Thereafter no refund can be made.
Comments:

Credit Card Information

Type of Credit Card:

    
        Select one.

Card Number:   Numbers only, no dashes or spaces.
Exp Date:    mm/yy    Must be 2 numbers  /  2 numbers.
Name on card:   Name on the card.
Verification Code    Must be 3 numbers found on back of card, except 4 numbers on front for AmEx.
Billing Street Address:   Street address for card bill. City and state not required unless outside of the US.
Billing Zip Code:   Zip code for card bill.

For questions, please call 540.951.2559, Fax 540.953.0230 or E-mail: office@masaav.org

            

Veterinarian and Student Registration Form

Printable forms are available to print and mail by clicking the "Forms to Print" button above.

General Session - 10-12 April 2011

Includes Proceedings (CD), any Lecture, Reception,
Exhibitors Gallery and Monday Luncheon
The General Session is available only as a 3 day package. Individual reduced fee days are not available.

General Session is 17 Continuing Education Contact Hours

Laboratories provide additional hours. See each lab below.

Do not use this form to register for any single day session!

Membership Information
Title:  Dr, Mr, Ms
First Name
Last Name
Diplomate Certification
Mailing Address
City
State
Zip Code + 4
Country
Email Address   Required so we can confirm your registration. Your email address is never listed anywhere or given outside of MASAAV.
Home Phone Numbers only. No space, paren, dash, comma or period. Never published but used only if a problem develops with your registration.

Veterinary Practice or Educational Affiliation Information
Practice Name
Practice Town
Practice State
Practice Zip Code
Work Phone Numbers only. No space, paren, dash, comma or period
Fax Numbers only. No space, paren, dash, comma or period
Website This should be of the format www.yourwebsite.com. It is not your email address.

MASAAV publishes a member veterinarians list on the Internet;
 http://masaav.org/mbrsearch.htm
member veterinarians are listed unless otherwise requested.

Only the member veterinarian's name, practice name, practice city, state, zip code and website plus work phone  and fax number are listed in this directory.

Do not include me in the MASAAV directory online or if requested by clients.   

General Session Registration
Registration Category
Click on the drop-down-list arrow (downward pointing arrow at right end of the box to the right) and choose the appropriate category.
Select
Veterinarian, Resident, Intern,
Veterinary Student, Technician Student
Executive Board Volunteer? Check for yes      Can you serve on committees or the Executive Board?
Executive Board Meeting? Check for yes     Can you attend the Executive Board Meeting Saturday (the night before the conference begins) at 8:00 PM?
Current Membership?
Application Form		 Check for yes     Did you renew membership before 1 March 2011?
                     Pay non-member fee in next block, if you did not check yes.
Non-Member Fee $100 $ Due for all non-members - not applicable to students
General Session Fee $100 Student - Veterinary or Technician
$300   Intern/Resident
$450   Veterinarian
$ Enter the amount that corresponds to your category
Luncheon Guests on Monday
Vegetarian selections provided.		   Enter the total number of guests you will bring
Guest Luncheon $28 $ Enter the total amount due, $28 for each guest

Wet Lab Registration
Basic Avian Techniques Lab
- Sunday  $150 - 3 hours		 $ Enter the amount due, $150 if you take this wet lab.
Emergency Techniques Lab for Small Exotic Mammals Lab - Sunday  $150 - 3 hours $ Enter the amount due, $150 if you take this wet lab.
Advanced Avian Techniques Lab - Monday  $150 - 3 hours $ Enter the amount due, $150 if you take this wet lab.
Conference Proceedings One CD copy of 2011 proceedings is included with registration. 
Printed Proceedings $55

Printed copies of the proceedings must be ordered.
CD copy is included with printed copy.

 Printed proceedings are available for years 1985 through 2011. Click for contents list.
$   Enter the amount due, $55 for each copy.

Total Due --->  

$   Enter the amount of money due.

Partial refunds, less 25%, can be made until 14 March 2011. Thereafter no refund can be made.
Comments:

Credit Card Information

Type of Credit Card:

    
        Select one.

Card Number:   Numbers only, no dashes or spaces.
Exp Date:    mm/yy    Must be 2 numbers  /  2 numbers.
Name on card:   Name on the card.
Verification Code    Must be 3 numbers found on back of card, except 4 numbers on front for AmEx.
Billing Street Address:   Street address for card bill. City and state not required unless outside of the US.
Billing Zip Code:   Zip code for card bill.

For questions, please call 540.951.2559, Fax 540.953.0230 or E-mail: office@masaav.org

            

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