National Euthanasia Registry A continuing education program of the Raptor Education Foundation
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NER Registration is limited
to individual veterinarians- multiple registrations (per clinic or
animal shelter) 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 Credit Card #_________________________________________Visa and Master Card only Expiration Date _____/_____/_____ _____________________________________________________ Mail To: NER |