Register

Conference Dates: March 4 - March 6 , 2012

Last day to register online or by mail, fax, or phone is February 23.

• Online registration
• Fill out the form below to register by mail or fax:

Please use one registration form per person

Please Select One:
DVM Capt. Dir. Lt. Sgt. Mgr. ACO ACT ASO
FSO RVT Veterinary Assistant Other: ________________________

Attendee Name: ______________________________________________________

Name as if would appear on Name Badge: _________________________________

Company/Agency: ____________________________________________________

Address: ____________________________________________________________

City: _______________________________ State: _____ Zip: ________________

Phone: ______________________________ Fax: ___________________________

E-Mail: ______________________________________________________________

I plan to attend the following track(s):
Behavior & Training Field Services
Management Services Shelter Medicine

Conference Fees:

Pre-Conference Workshop (Saturday, March 3, 2012, 10:00 a.m. - 4:00 p.m.):
___ $150 - Lunch included

Early Bird Registration (through February 10, 2012): $_________
___ $250 Members-Affiliation: CACDA CVMA SHAC (select if applicable)
___ $300 Non-members
___ $100 F/T Students
___ $150 One-day Sunday Monday Tuesday (select day)

Standard Registration (after February 10, 2012 or On-Site): $_________
___ $300 Members-Affiliation: CACDA CVMA SHAC (select if applicable)
___ $350 Non-members
___ $150 F/T Students
___ $175 One-day Sunday Monday Tuesday (select day)

___ $150 Guest Badge 2-day Exhibit Hall pass & meals (no admittance to CE)
Guest Name: ______________________________________________

___ $75 Guest Badge 1-day Exhibit Hall pass & meals (no admittance to CE)
Guest Name: ______________________________________________
Will be attending Exhibit Hall on Sunday Monday (select day)

Total Payment: $__________

Payment Contact:______________________________ Phone:_______________

Payment Type: Check Mastercard Visa

Make check payable to: Animal Care Conference

Card number: ________________________________________________________

Exp Date: ________________________ CVV #: ___ ___ ___

Name on Credit Card: __________________________________________________

Billing Address (if different than above): _________________________________

City, State, Zip: ______________________________________________________

Contact person if other than registrant:

Name: ______________________________________________________________

Phone: _____________________ Email: __________________________________

Mail to:
Animal Care Conference
1400 River Park Drive, Suite 100
Sacramento, CA 95815
or fax to:
(916) 646-9156

REFUND POLICY: Notice of cancellation must be received in writing by the Animal Care Conference no later than January 30, 2012 to receive a full refund, less a 10% administrative fee. No refunds will be issued for cancellations made after January 30, 2012. Cancellations must be made via mail, fax or email only.

If you have any questions, please call 916.649.0599.