Page 1 of 5 CVC WASHINGTON, D.C. April 23-26, 2015 PRioRITY CODE: DC15CVC One registration per form. For additional registrations please copy form. Please send all five pages. REGiSTRation TYPE please check one: Veterinarian Technician Practice Manager Student (2014) Veterinary Grad (2014) Hospital Staff Spouse Last Name Degree Clinic Name Street Address: Please SeleCT One Work Address Home Address City State Zip Code Country Email Address ( to receive your convention confirmation ) Twitter Username: Daytime Telephone Number with Area Code @ Fax Number with Area Code ext. How many years have you attended CVC? Number of years, including 2015: A Few Questions: 1 2 Please list university attended: Year graduated: What is your practice type? ( Circle one ) A. Private Practice B. Specialty Practice C. Emergency Practice D. Corporate Practice E. Shelter F. Teaching Hospital G. Mobile Practice 3 What is your job function/title? ( Check one ) 0065 Veterinarian 0020 Practice Manager 0015 Technician 0040 Veterinary Assistant 0070 Faculty of Veterinary College 0030 Receptionist 0060 Student 0100 Affiliated with Industry 0090 Spouse 4 Check here if you do not want to receive convention information via email. Choose the specialty that best describes your business or professional activity. ( Check one ) 0001 Exclusive Small Animal Practice 0002 Over 50% Small Animal Practice 0003 Mixed Practice ( 50%-50% ) 0004 Cattle ( Exclusive Large Animal Practice ) 0005 Horse ( Exclusive Large Animal Practice 0006 Swine ( Exclusive Large Animal Practice ) 0007 Large Animal Practice 0008 Over 50% Large Animal Practice 0009 Exotic Animals 0010 Retired/Non-Practicing Veterinarian 0011 Government: Federal, State, Municipal, Armed Forces RegisrtationForm 5 What type of content are you interested in? ( Check all that apply ) a Anesthesia b Behavior c Bovine Medicine and Surgery d Cardiology e Clinical Pathology f Clinical Pharmacology g Dentistry h Dermatology i Emergency and Critical Care j Endocrinology k Equine Medicine and Surgery l Exotic Animal/Avian Medicine m Feline Medicine n Gastrointestinal Medicine o Geriatrics p Imaging q Immunology r Internal Medicine ( other: hemolymphatic, liver, diagnostic testing, diagnostic techniques ) s Infectious Diseases t Neurology/Musculoskeletal u Nutrition v Oncology w Ophthalmology ( small animal ) x Ophthalmology ( equine ) y Orthopedics/Sports Medicine/Physical Rehabilitation z Pain Management aa Parasitology bb Pediatrics cc Practice Management dd Reproduction ee Respiratory Medicine ff Shelter Medicine gg Small Ruminant Medicine and Surgery hh Soft Tissue Surgery ii Toxicology jj Urology kk Wellness/Preventive Medicine 6 How did you hear about this convention? Program Catalog Postcard/Brochure Letter Print Ad Email Web Ad Referral from Friend/Colleague Facebook or Twitter Phone Call from CVC Other (please specify): 45
Registration Form Page 2 of 5 Registration inclusions: These items are included in your registration fee please check one. Lunch Preference: Regular Vegetarian Proceedings: CD-ROM Downloadable (Available one week before the convention) A proceedings book is ONLY available by advance purchase. (see p. 49 of the Registration Form to add to your registration.) VETERINARIANS CVC Programs and Packages for Veterinarians / Please circle day or days you will attend CVC: By 1/28/15 By 3/11/15 After 3/11/15 v01 Veterinarian ( four-day ) $529 $559 $659 v02 Veterinarian ( two-day ) Thursday Friday Sunday $449 $469 $571 v08 Veterinarian ( one-day ) Thursday Friday Sunday $339 $359 $466 vsg Veterinary Graduate ( in 2014) Proof is required. $259 $279 $379 vs Veterinary Student ( within calendar year ) Proof is required. $55 $60 $70 Specialty Focus : Abdominal Ultrasonography / Please circle day or days you will attend CVC: sf102 Lab + CVC Veterinarian ( two-day ) Thursday Friday $1,869 $1,939 $2,039 sf103 Lab + CVC Veterinarian ( one-day ) Thursday Friday $1,759 $1,829 $1,929 sf120 Lab only $1,649 $1,719 $1,819 VHMA Veterinary Hospital Managers Association / Please circle day or days you will attend CVC: VHO VHMA Only Registration $275 $275 $275 V1VH Veterinarian 4 day + VHMA Registration $779 $809 $909 V2VH Veterinarian 2 day + VHMA Registration Thursday Friday Sunday $699 $719 $821 V8VH Veterinarian 1 day + VHMA Registration Thursday Friday Sunday $589 $609 $716 TECHNICIANS CVC Programs and Packages for Technicians / Please circle day or days you will attend CVC: t20 Veterinary Technician ( four-day ) $329 $359 $459 t01 Veterinary Technician ( three-day ) Thursday Friday Sunday $299 $329 $429 t02 Veterinary Technician ( two-day ) Thursday Friday Sunday $269 $299 $399 t05 Veterinary Technician ( one-day ) Thursday Friday Sunday $219 $249 $349 ts1 Veterinary Technician Student ( within calendar year ) Proof is required. $55 $60 $70 PRACTICE MANAGERS CVC Programs and Packages for Practice Managers p01 CVC Practice Manager Registration only ( non-veterinarian ) $299 $399 $429 VHMA Veterinary Hospital Managers Association PM-PVO CVC Practice Manager VHMA Only Registration $275 $275 $275 PM-P01 CVC Practice Manager + VHMA Registration $549 $649 $679 pr02 Veterinary Pet Insurance Reception () CVC Combo Required Yes, I will attend (RSVP appreciated) FREE SPOUSES CVC Programs and Packages for Spouses s01 Spouse Attending Seminars ( non-veterinarian ) $299 $399 $429 TOTAL FROM THIS PAGE $ 46
Page 3 of 5 additional PRoGRammiNG Companion Therapy Laser Industry Symposium (Friday) c03 Yes, I will attend (RSVP Required) FREE Orthomed MMP for TTA (Friday) mm01 Lab only $600 mm02 Lab + Additional CVC registration option selected on p. 46 $600 + CVC Registration Jorvet/Abaxis Mast Cell Tumor Workshop () c04 Yes, I will attend (RSVP Required) FREE Veterinary Medicine Clinical Techniques Courses Thursday L1 Vital Soft Tissue Surgeries: All About Cats $675 $675 $700 Friday L2 Dental Essentials in Dogs and Cats $675 $675 $700 L3 Insights Seminar: The Cooperative Practice $185 $185 $210 L4 Essential Gastrointestinal Surgeries in Dogs $675 $675 $700 L4 Eyelid and Corneal Repair Surgeries $375 $375 $400 RegistrationForm L5 Digital Dental Imaging $375 $375 $400 L6 Stabilization Techniques for Luxating Patellas $495 $495 $520 L7 Vital Soft Tissue Surgeries: All About Dogs $675 $675 $700 Sunday L8 Extracapsular Stifle Stabilization Techniques $495 $495 $520 L9 Tools of the Trade: Cytologic Interpretation $275 $275 $300 L10 Essential Dental Techniques for Technicians $275 $275 $300 Total From Clinical Techniques Courses $ Total From this Page $ 47
Registration Form Page 4 of 5 Ask The expert luncheons Friday Sunday a01 $50 Clinical Pharmacology Dr. D. Ferguson a03 $50 Internal Medicine Dr. K. Tefft a05 $50 Dentistry Dr. E. Eisner a02 $50 Imaging Dr. R. O Brien a04 $50 Practice Management B. Halow a06 $50 Pain Management Dr. M. Petty Total From Luncheons $ ChilDCaRE Thursday cth Friday cfr csa Sunday csu $75 per child, per day by March 11. Onsite Registration is $100 per child, per day, subject to availability. Child 1 Name: Age: Child 2 Name: Age: Total From Child Care $ ToURS Thursday tr1 Monuments by Moonlight (Thursday) $54 per person x No. of tickets = $ Friday tr2 Memorials by Moonlight (Friday) $54 per person x No. of tickets = $ tr3 Monuments by Moonlight () $54 per person x No. of tickets = $ Total From Tours $ FRIDAY yfr Yes, I will attend (FREE) Yoga ClaSS RSVP ysa Yes, I will attend (FREE) SUNDay ysu Yes, I will attend (FREE) Total From this Page $ 48
Page 5 of 5 ChriSTian VETERinaRY MiSSion cs Evening Seminar (FREE) RSVP number of people attending Sunday cb Morning Fellowship (FREE) RSVP number of people attending CVC ProDUCTS A book is available by advance purchase ONLY. Additional CD-ROMs and downloadable proceedings will be sold for $75 each at the Registration Desk. Attendees receive a complimentary CD or downloadable proceeding on p. 46. USE THIS SECTION TO ORDER ADDITIONAL COPIES ONLY. Proceedings Book x $60 (Not available onsite) = $ Proceedings CD-ROM x $60 (Onsite price is $75) = $ Audio Recordings Pre-order your full set of CVC Washington, D.C. MP3s (Audio recordings by subject will be available to order onsite.) GUEST BaDGES x $499 = $ Last Name Last Name Total For CVC Products $ Guests are defined as people not working in the veterinary industry. All veterinarians, technicians, practice managers, and team members must register and pay registration fees. ( A $5 processing fee will be charged onsite for guest badges. ) SPECial NEEDS Please check here if you have special needs. If you have a disability that may affect your participation in this meeting, please check this box and include a statement regarding your needs (see right). We will contact you (if applicable) to discuss accommodations. We cannot ensure the availability of appropriate arrangements without early notification, but every effort will be made to meet your needs. PaymENT information Check Enclosed Credit Card: Please fill in credit information below. ( please make check payable to American Express Discover Advanstar Communications Inc. ) MasterCard Visa Card Number Expires Cardholder Name: Security Code Credit card expiration must be valid through April, 2015. Your credit card statement will reflect a charge from Advanstar Communications Inc. Refunds for cancellation must be requested in writing by mail or fax and received by March 18, 2015. A $ 50 processing fee applies. Total From p. 46 $ Total From p. 47 $ Total From p. 48 $ Total From p. 49 $ Grand Total: $ RegistrationForm 49
CVC WASHINGTON, D.C. April 23-26, 2015 Gaylord National Resort & Convention Center, National Harbor, MD Visit TheCVC.com to make reservations. Call (800) 221-3531 for reservations by phone. International callers dial (212) 532-1660. By mail, send form to: Travel Planners, CVC Washington, D.C., 381 Park Ave. S., New York, ny 10016 Do not mail or fax this form with your CVC registration. Last Name Degree Clinic Name Street Address City State Zip Code Daytime Telephone Number with Area Code Fax Number with Area Code Country Code Email Address Arrival Date Arrival Time Departure Date 1 5 : 1 5 Sharing Room: Last Name Hotels& Housing Sharing Room: Last Name Hotel Choice Number in order of preference (1-4) Gaylord National Resort aloft Washington National Harbor Hampton Inn & Suites National Harbor Residence Inn National Harbor Accommodations (room type) Mark first and second choice 1 Bed 2 Beds Number of people in room Special Requests I have a disability, want to be near elevators, need cots or baby crib (if available) Specify: hotel accommodations: Gaylord National Resort (Additional $10 resort fee not included) SINGLE, DOUBLE, or DBL/DBL 1 or 2 people TRIPLE 3 people quad 4 people check- IN time amenities (see below) $203 $223 $243 3:00 pm AG, HC, IP, OP, R, WD aloft Washington National Harbor $195 $195 $195 3:00 pm AG, HC, IP, R, WD Hampton Inn & Suites National Harbor $199 $199 $199 3:00 pm AG, B, HC, IP, WD Residence Inn National Harbor* $189 $189 n/a 3:00 pm AG, B, HC, IP, WD To receive special CVC Washington D.C. rates, make your reservation by March 18, 2015. Key: AG Accessible Guest Rooms B Complimentary Breakfast HC Health Club IP Indoor Pool OP Heated Outdoor Pool R Restaurant WD Walking Distance to Convention Center *Residence Inn offers only studio suites with one king bed and a single sofa sleeper. Please use your discretion in selecting this hotel for more than two occupants per room. Minimum two-night stay required. 10% occupancy tax and 6% state tourism tax not included in above rates. Deposit Requirement: All hotels require a deposit of the first night s room rate and applicable sales tax with each reservation request. Requests received without a deposit will be returned and will not be processed. Please fill out the credit card information entirely or mail a check made payable to Travel Planners Inc. The hotel holding your reservation will charge credit card deposits on or after March 23, 2015. Credit cards must be valid through April 2015 to be considered a proper deposit. Credit Card: American Express Diners Club Discover MasterCard Visa Card Number: Security Code: Name on Card (required): Exp. Date: Modification/Cancellation: Please refer to the policy on p. 50 or online at TheCVC.com. Reservations may be modified and/or cancelled without penalty until three days before arrival. Cancellations made less than three days before arrival will result in forfeiture of one night s room fee and tax. 51