AAEP 66TH ANNUAL CONVENTION
Advance Registration Form After Nov. 11, please register online or on-site at the convention.
Full name: _________________________________ FIRST
______________________________ MIDDLE
_______________________________ LAST
Credential (DVM,VMD, etc.): _______________________ Preferred first name on badge: ______________________________ Address: ________________________________________________________ City: _____________________________________ State: ___________ Postal Code or Zip: ____________________________ Country: __________________________________ Phone: ________________________ Cell Phone (optional): _______________________ Fax: _________________________
Do you want to receive a copy of the Proceedings book on-site? Yes No If you choose to not receive a Proceedings copy, you will still have access to the digital edition. Email: _____________________________________________________ Please remove me from all exhibitor mailing lists
Dietary requirements: Vegetarian Vegan Gluten Free Vegetarian & Gluten Free Vegan & Gluten Free Other, I will make other arrangements I do not have any meal requirements Emergency contact name (required): ___________________________________________________________________________ Phone: ____________________________________________________________________________________________________ Full name of guest (limit 2 per member): ________________________________________________________________________ Preferred first name on guest badge: __________________________________________________________________________ Address/City/State/Zip Code (guest): __________________________________________________________________________ Phone (guest): ________________________________________ Email (guest): _________________________________________ First-time convention attendee
Thru Thru Sept. 15 Dec. 3
A. AAEP Member
B. AAEP Honor Roll Member C. Guest Attending Sessions* D. Guest Pass**
E. AAEP New Member Applicant F. Non-Member
G. Current Resident or Intern
H. International Members’ Reception (Dec. 7; ticket required) I. President’s Luncheon (per person) Qty ____ Dec. 8 J. After Party (Dec. 8; ticket required) K. Wet & Dry Lab Experiences
* Can be purchased only by AAEP members. Limit 2 per member.
$499 300 499 30
800 995 300
60
$599 300 599 30
880 995 300
60
On-site $699
400 699 50
980
1,095 400
60
Total _____ _____ _____ _____ _____ _____ _____ Free
_____ Free
(Register online or by phone; see page 12) Total:
_____ ** Can be purchased only by registered attendees. No access to sessions. Limit 2 per attendee.
I have read and agree to the disclosure statement on page 18 Payment Method: Visa MasterCard American Express Discover Card Check enclosed _________ Card #: _______________________________________________ Expiration: ______________ CVV Code: _____________
Signature: ______________________________________________________ Date: ________________________________ Return your registration and payment (if applicable) to AAEP, Attn: Meetings Registration, 4033 Iron Works Pkwy, Lexington, KY 40511; or fax with credit card information to (859) 233-1968. Last day to register by mail or fax is Wednesday, Nov. 11.
SHARE #AAEPVegas | AAEP 17
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