Registration Form Printable forms are available to print and mail by clicking the "Forms to Print" button above. Technician Program (Sunday Only) - Sunday, 10 April 2011 Includes any Sunday Lectures, Proceedings (CD), Exhibitors Gallery Reception, and Basic Avian Techniques Laboratory

This registration is available only as a 1-day Sunday package for technicians sponsored by member veterinarians. This technician one day program is 10 Continuing Education Contact Hours

Do not use this form to register for any veterinary program or the General Session!

Additional days for technicians require General Session registration instead, but do not include a lab without an added fee. This single day reduced rate, which includes the Basic Avian Techniques Lab, is only available to technicians sponsored by a veterinarian who is a current member of the Mid-Atlantic States Association of Avian Veterinarians. Neither membership nor non-member fees are required of the sponsored technician who is attending only the Technician Session.  The sponsoring veterinarian must be or become a MASAAV member and submit the membership fees for the current year, if not already paid.

 

Technician Information
Name of Sponsoring MASAAV member Veterinarian:
Is this veterinarian a current member?	Check for yes If not a member, click here for membership application and payment.
Title:  Mr., Ms. First Name Last Name Certification
Mailing Address City State Zip Code + 4 Country
Email Address Home Phone	Required so we can confirm your registration. Your email address is never listed anywhere or given outside of MASAAV. Numbers only. No space, paren, dash, comma or period. Never published but used only if a problem develops with your registration.
Veterinary Practice Information
Practice Name Practice Town Practice State Practice Zip Code Work Phone Fax	Numbers only. No space, paren, dash, comma or period Numbers only. No space, paren, dash, comma or period
Technicians attending this one day session are not required to become members. If membership is desired, click here for a separate membership application and payment.
Technician Session Registration
Technician Session Fee	$250
Basic Avian Techniques Wet Lab is Included in Registration Fee
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 Type of Card MasterCard Visa Discover Card American Express        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.

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