International Society of Veterinary Dermatopathology

ISVD & WCVD6 1/2 day Dermatopathology Workshops

REGISTRATION FORM
DATE: to be determined during the WCVD6 congress in November 2008.

This form is for those not attending WCVD6.

Please do not use this form if you are also registering for the dermatology congress.

In that case please register onlinewith WCVD6

Name and degree____________________________________________________________

Hospital/Company/Institutional affiliation_________________________________________

Street address_______________________________________________________________

City_________________________________________________State__________________

Country___________________________________Zip/Postal code____________________

Telephone_____________________________Fax__________________________________

E-mail address_______________________________________________________________


REGISTRATION FEES (please check one):
$ 110 US (or equivalent other currency) for ISVD members ___
$ 135 US (or equivalent other currency) for non-members ___

$ 85 US (or equivalent other currency ) for residents ___

Registration includes the half day workshop.

____ I am registering for Workshop 1: Dermatopathology for Beginners

____ I am registering for Workshop 2: Advanced Dermatopathology : selected case discussion


___I have enclosed a check or money order in US dollars. (Checks for US $ must be drawn on a US bank.)

I am paying by ___VISA ___Mastercard Signature___________________________________

Card number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expiration date (MM/YY) ___/___

Address where you receive your credit card statements (if different from above):

_____________________________________________________________________________

City_________________________Country__________________Zip/Postal code_____________

Please mail to:

ISVD c/o Emily J Walder, VMD
623 Woodlawn Ave
Venice, CA 90291 USA

Or: For credit card payments only, fax to: (00-1-)310-574-3330.

(For security reasons, please do not email credit card information.)