ACVO Service Dog Eye Exam Event
*May, 2010
Veterinary Ophthalmologist Registration Form
  
Thank you for agreeing to participate in the 2010 Service Dog event. Please submit one registration form for each ophthalmologist participating in your clinic. Submit the contact information that you would like to be provided to clients to make appointments. We will use this data to calculate the total number of participants.

As was done in past years, the client will be forced to register prior to being supplied your contact information. Once they register they will receive a confirmation with a registration number, they should be able to bring this document to your clinic on the day of the appointment. Your personal name will not be made available but the client will call the clinic in general to set the appointment, which will occur according to your clinic's determination.

Early commitment on your behalf will help us in our promotional efforts. Please register early when possible!

(*Important note - The date of the event has been changed from one week in length to the entire month of May, effectively creating the Service Dog Eye Exam Month. You may still determine availability as you see fit for the event, e.g. over one week, one day each week, several 1/2 days scattered throughout the month, etc. Clients will be informed to contact your clinic for specific dates.)

  
OPHTHALMOLOGIST INFORMATION - Please submit one form per doctor.
Clinic name:
Veterinarian:
Street Address: (where appointment will take place)
City:    State: Postal code:
Telephone: (to be provided to client to make appointment)
Email: (optional) (only if you want clients to make appointments via this method)
Website: (optional) (for your clinic's promotional purposes)
  

Select the submit button to finalize your registration. If you need to change any data contact us at office09ATacvo.org.