Nebraska Veterinary Medical Association Summer Meeting 12-14, 2017 River’s Edge Convention Center, Columbus, NE

Return Form to: NVMA PO Box 637 Hastings, NE 68902 Phone: 402-463-4704 Fax: 402-463-4705 Before 5/19/17 After 5/19/17 SUBTOTAL

I. CONVENTION REGISTRATION NVMA & OUT OF STATE VMA MEMBERS Full Registration (10 CE’S) Tuesday only, June 13th only (6 ½ CE’s)

$150.00 $120.00

$200.00 $170.00

_________ _________

$275.00 $245.00

$325.00 $295.00

_________ _________

$ 90.00 $ 60.00 $135.00 $105.00 $ 50.00

$140.00 $110.00 $185.00 $155.00 $ 100.00 N/C

_________ _________

NON-MEMBERS Full Registration (10 CE’s) Tuesday only, June 13th only (6 ½ CE’s)

TECHNICIANS NVMA Member technician (10 CE’s) Tuesday only, June 13th only (6 ½ CE’s) Non-Member (10 CE’s) Non-Member, Tuesday June 13th only (6 ½ CE’s)

NVMA RETIRED MEMBERS STUDENTS (Meal ticket included)

(NO CE CREDIT)

N/C

__________

Veterinary Student ____ Technician Student ____ Pre-Vet Student ____

$__________

TOTAL REGISTRATION FEES II. MEALS: You MUST check to receive a complimentary lunch ticket with registration if stated above. Steak Fry, Monday, June 12th

__Not attending

Wine & Cheese Social at Kramer’s June 12

th

Business Luncheon; Tuesday, June 13th Brisket in the Park Dinner, Tuesday, June 13

th

__# Attending __# Attending

__Not attending

__ 1 Free

___Add’l ticket $17

$____________

__Not attending

__$15 ea.

$____________

TOTAL MEAL FEES

$__________

III. ACTIVITIES NVMA Memorial NVMA Golf Tournament Monday, June 12th (see in booklet) NVMA Memorial Sporting Clays Shoot Monday, June 12

th

(see in booklet)

nd

Shoot 2 round after lunch

___$ 65.00

$__________

___$ 43.00

$____________

___$ 36.00

$____________

TOTAL ACTIVITY FEES

TOTAL FEES

$__________

$__________

IV. PAYMENT INFORMATION (one registration form per attendee) Name________________________________________________________ __DVM __PhD __Technician __Student

Name for Badge_______________________________

Address_________________________________________City______________________________State________Zip_____________ Daytime Phone (_______) ________-__________

□ I have enclosed a check for $_____________ (payable to NVMA) □ Please Charge my Credit Card ( MasterCard or Visa)

Account #______________________________________________________ Amount $______________3 digit code _____________

Cardholder Signature_______________________________________________________Exp. Date_______________