National Euthanasia Registry

A continuing education program of the Raptor Education Foundation
copyright, 2000, Raptor Education Foundation

NER Registration is limited to individual veterinarians- multiple registrations (per clinic or animal shelter) 
are not available i.e., each veterinarian in the clinic must be an NER member and 
register independently.  Sign-up and pay online for faster processing and protection.

 Name-_________________________________________________REGISTRATION FORM

Clinic Name-_________________________________________________

Address- _____________________________________________________

City___________________  County_________________ State_______ Zip___________

Phone______________________________                        Fax______________________

E-mail______________________________  Registration date ______/______/______

Veterinarian License#________________________ Years in practice____________ 

  Registration Fee: $75.00 first year-Introductory Offer
Subsequent Years: $50--Fees are tax-deductible

Checks or Credit Card

 Credit Card #_________________________________________Visa and Master Card only

 Expiration Date _____/_____/_____

                                authorized signature

Mail To: NER
             C/O  Raptor Education Foundation
               P.O. Box 200400
               Denver, Colorado  80220 Phone:303-680-8500/Fax: 303-680-8502

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