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College of Veterinary Medicine
Office of Continuing Education & Outreach

Dental Radiography
Technique, Interpretation and Equipment

April 5, 2008

REGISTRATION

Please fill out one form for each person attending.

Fill out the fields below, print the page and mail or fax.

To pay by check: Checks should be made payable to NC State University and mailed to:
NC State College of Veterinary Medicine
Office of Continuing Education
4700 Hillsborough Street
Raleigh, NC 27606-1499

To pay by credit card: mail as above, or fax to: 919-513-6689

Name:
Degree(s):
DVM/VMD RVT/LVT Other________________________
Address:
City:
State
ZIP:
Phone:
Fax:
E-mail:
Credit Card#:
Exp. Date:
MasterCard
VISA
Signature:
______________________________________________________________
Fees:
$75 for morning lectures
 
I prefer a vegetarian lunch
   
 

 

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NC State College of Veterinary Medicine
Office of Continuing Education & Outreach
 4700 Hillsborough Street
Raleigh, NC 27606
919-513-6259