Fillable Equine Dental Registration Form

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Equine Dental Registration Form

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The Equine Dental Registration Form form is 1 page long and contains:

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  • 15 other fields

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File type: PDF

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BASIC EQUINE DENTAL TRAINING PROGRAM
July 13-16, 2016
Registration Form
Participant’s Name: _______________________________________________________
Address: ________________________________________________________________
__________________________________________________________________
__________________________________________________________________
City State Zip
Daytime Phone Number: (________)___________-_________________________
Email Address: _____________________________________________
Are you presently employed by a Veterinarian licensed in Louisiana? ____Yes ____No
If yes, name of Veterinarian: _______________________________________________
Signature of participant: ____________________________________________________
Course Fee: $800.00 Please make check payable to LSU School of Veterinary Medicine.
Mail payment and Registration to:
LSU School of Veterinary Medicine
Equine Health Studies Program
Dept. VCS
Baton Rouge, LA 70703
ATTN: Dr. Charles McCauley
Registration Deadline: July 8, 2016
Thank you!
Questions, please call 225-578-9500. Ask for Dr. Chuck McCauley.
Office Use Only:
Fee paid? ___Y ___N Check #___________________
Initials:___________
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Equine Dental Registration Form

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Completed 19 June 2020

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