Online Registration

Hospital Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Person 1

Name

First Last

Title (DVM, LVT, etc)

Cell Phone

Email

Amount Paid

Do you want to add another person?

Yes
No

Person 2

Name

First Last

Title (DVM, LVT, etc)

Cell Phone

Email

Amount Paid

Do you want to add another person?

Yes
No

Person 3

Name

First Last

Title (DVM, LVT, etc)

Cell Phone

Email

Amount Paid

Do you want to add another person?

Yes
No

Person 4

Name

First Last

Title (DVM, LVT, etc)

Cell Phone

Email

Amount Paid

Do you want to add another person?

Yes
No

Person 5

Name

First Last

Title (DVM, LVT, etc)

Cell Phone

Email

Amount Paid

Payment

Dues (Per Person)

Veterinarians - $250.00 for all lectures

Technicians/Practice Managers - $100.00 for all lectures

Individual Lecture - $100.00 for each individual lecture (please indicate which lectures below)

Total Paid

Pay Type

Cash
Check

If check, please indicate check #:

***Please note: Payment is due before the meeting to be attended. BAVM will NOT be billing.

Continuing education credit will not be awarded if payment is not made for meetings attended.

* Please make checks payable to: “Buffalo Academy of Veterinary Medicine” (checks should be payable in U.S. FUNDS only)

Person 1

Person 2

Person 3

Person 4

Person 5

Payment

Dues (Per Person)

Online Payment Portal

Pay for your lecture through our secure PayPal portal. Use your mobile phone to scan the QR Code and pay online.

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