2007 Illinois State Veterinary Medical Association (ISVMA) Convention REGISTRATION FORM

Full Name:
(Please enter your name as you wish it to appear on your badge)

Spouse/Guest Name: (if your spouse/guest intends to join you at convention (i.e. wants access to exhibit hall, meals and activities) they must also register and pay the spouse/guest fee.

Business Name:

Address:

City: State: ZIP:

Phone: Fax: Email:

FOR VETERINARIAN AND CVT REGISTRANTS:

College Name: Year of Graduation:

FOR DVM RECENT GRADUATES:

If you graduated from veterinary college in 2005, 2006 or 2007 you are eligible for discounted registration (50% savings) to attend the ISVMA Annual Convention.

This discount is an acknowledgement on behalf of the members of ISVMA as to the importance of recent graduates supporting organized veterinary medicine through their participation in their state veterinary association.

A fantastic program has been developed just for Recent Graduates at the ISVMA Convention. This "convention within a convention" has been very successful ever since its introduction during the 2005 ISVMA Annual Convention and we hope to see it grow every year!

FOR STUDENTS:

Indicate either: DVM Student Vet-tech Student

College Name: Year of Graduation:

FOR ALL OTHER ATTENDEES (You must answer to have your credentials accurately reflected on your badge and for ISVMA to accurately report attendance by category):

Indicate Either: CVT Vet Asst. Practice Personnel Auxiliary Guest Other

If Other, please specify:

ESSENTIALS: Food Preferences and Special Needs

Your lunches are included in the registration fee; please indicate if you have a preference for one of the following special diets:

vegetarian fish instead of red meat diabetic

Please check this box if you have a disability or limitation that would require special arrangements. We will contact you to discuss accomodations.

EVENT REGISTRATION AND PAYMENT: