PRIMA Move Canine Cruciate Ligament Disease Registration PRIMA Move - Canine Cruciate Ligament Disease Registration Registration Step 1 of 3 33% Registrations are accepted from qualified applicants. Registration will be open until June 7, 2019, or until the course fills. Limited to 35 veterinarians. Basic InformationName* First Last Title DVM VMD Other If 'Other,' please provide your title hereName for Certificate of Completion (including degrees)*Practice Focus (check all that apply) Large Animal Small Animal Equine Exotic Other If 'Other,' please specify your practice focusVeterinary College and Year of Graduation*State Where LicensedLicense Number (upload a copy of your license below)Upload a copy of your current veterinary license or letter from your school showing that you are a student in good standing or a faculty member that does not require a veterinary license to teach and practice. You will be enrolled in the course once this has been received, reviewed, and accepted.Accepted file types: pdf, jpg, png, .Formats accepted are pdf, jpg, png. The file will upload when you submit the form.Acupuncture program(s) completed (MAV, IVAS, or Chi)*Upload a copy of your veterinary acupuncture certification, or call Sharon Sherwood at CuraCore if you have any questions. 970-818-0851Accepted file types: pdf, jpg, png, .Formats accepted are pdf, jpg, png. The file will upload when you submit the form.How did you hear about us? (check all that apply)* Website Friend/Co-worker School Conference Social Media Other Please indicate the school, conference, or explain other:Dietary Requests Vegetarian Vegan Gluten Free/Sensitive Dairy Free Other If other, please describe dietary request here: Contact InformationMailing Address (for your certificate upon completion)* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Is this address your home or work address? Home Work Work PhoneCell PhoneEmail Address (preferred for course material)* Terms and Conditions Returned Check Policy There will be a $35 fee for checks returned for insufficient funds and course will be suspended until payment clears. Cancellation Policy CURACORE VET reserves the right to cancel the course. A full refund will be given if the course is cancelled. No refunds will be granted once you have started the course. I understand that by submitting this registration form and the course registration fee is non-refundable per policy. I have read, understood, and agree to the terms and conditions contained herein. I further understand that by signing below, I have reviewed and agree to the course curriculum, subject to such changes as may be approved by CURACORE VET. Type your name in here to indicate that you agree to the terms outlined above*End User Agreement* I agree. Note: By clicking "I Agree" you acknowledge that you have read and agree to the terms set forth in the end user agreement. You must read the linked document and check the box above to continue with the form.Additional ItemsSign Up for Our Course Announcements Sign me up! PaymentsCourse FeePRIMA Move Integrative Rehabilitation: Canine Cruciate Ligament DiseaseCode Total $0.00 Will you be paying by credit card or check?*Credit CardCheck in US dollars (Check in US dollars (mail to CURACORE VET, 905 S Summit View, Fort Collins CO 80524)) Note: If paying by credit card, you will be asked to enter your billing address separately when checking out. If paying by check, please make payment to "CURACORE VET" and mail to: CURACORE VET 905 S Summit View, Fort Collins, CO 80524 Questions? Contact us at firstname.lastname@example.org or 970-818-0851.NameThis field is for validation purposes and should be left unchanged.