MAV Registration October 2019 Medical Acupuncture for Veterinarians Registration Oct 2019 Step 1 of 3 - Basic Information 33% Medical Acupuncture for Veterinarians Program - Fort Collins, Colorado. Course size is limited to ensure high-quality instruction for all participants. Registrations are accepted from qualified applicants on a first-come basis until we reach maximum enrollment. 2019 Fall Clinical Intensive Dates October 14-19, 2019 - Single Track and Dual Track Basic InformationName* First Last Preferred Name on BadgeTitle DVM MRCVS VMD Veterinary Student Name for Certificate of Completion (including degrees i.e. Jane Doe, DVM, cVMA)*Practice Focus (check all that apply) Large Animal Small Animal Equine Exotic Other If 'Other,' please specify your practice focusVeterinary College Graduated From*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.How did you hear about this course (check all that apply)* Website Friend/Co-worker School Conference Other Please indicate the school, conference or explain other:Interactive Medical Acupuncture Anatomy - Preferred version: (note the Kindle version does not include the DVD with rotatable model.)* Hard Copy Kindle All student applicants must be members of SAVMA and provide proof of professional liability insurance. Please upload below.Accepted file types: pdf, jpg, png.Formats accepted are pdf, jpg, png. The file will upload when you submit the form. 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Home Work Work PhoneCell Phone*Email Address (preferred for course material)* Program SelectionCheck the selection below that applies to you*VeterinarianFourth-Year Veterinary Student §§ Fourth-year students must provide a letter verifying that they are a student in good standing from the veterinary school's Dean's Office.Veterinarians - Oct 2019 Tracks - Please choose courseOct 2019 Dual Track: 12 Modules of MAV - $9,400Oct 2019 Single Track: 10 Modules of MAV - $8,700Veterinary Students - Oct 2019 Tracks - Please choose courseOct 2019 Dual Track: 12 Modules of MAV - $9,100Oct 2019 Single Track: 10 Modules of MAV - $8,400Single Track Clinical IntensivesSpecify which single track you are attending*Small Animal/ExoticsEquine/Farm Animals 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 or any clinical intensive(s), and to change the dates or venue of the intensive(s). 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 to reserve a seat in the upcoming MAV course that the course registration fee is non-refundable per policy. I understand that if I cannot attend the specified Clinical Intensive that there are fees that will occur to change to the next available Clinical Intensive. 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 ItemsDietary RequestsVegetarianVeganGluten Free/SensitiveOtherIf 'Other,' please describe dietary requestSign Up for Our Course Announcements Sign me up! PaymentsCoupon Code Will you be paying by credit card, check or wire transfer?*Credit CardCheck in US dollars (mail to CURACORE VET, 905 S Summit View, Fort Collins CO 80524)Wire Transfer (contact Sharon Sherwood at firstname.lastname@example.org for specific instructions) Note: If paying by credit card, you will be asked to enter your billing address separately when checking out. Total $0.00 If paying by check, please make payment to "CURACORE VET" and mail to: CURACORE VET 905 S Summit View Dr Fort Collins, CO 80524 For your security, please send payment with tracking information. Questions? 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