52nd Annual Veterinary Medical Symposium
Tuskegee University College of Veterinary Medicine
Wednesday – Saturday, March 22 – 25, 2017
ADMISSION TO PROFESSIONAL SESSIONS LIMITED TO
REGISTERED ATTENDEES
REGISTRATION FORM
Name ___________________________________________________________________________________________________________
(Please Print or Type)
Name of Spouse/Significant Other If Attending _________________________________________________________
Name of Alma Mater ____________________________________________________ Year DVM Earned ______________
Mailing Address ______________________________________________________________________________________________
City _________________________________________________ State ________________________ Zip Code _________________
Daytime Telephone _______________________________________ Cell Phone ____________________________________
Evening Phone ____________________________________________ Fax ______________________________________________
Email ___________________________________________________________________________________________________________
SYMPOSIUM REGISTRATION FEES:
 Full Registration
(Includes all activities: Scientific Sessions, State-of-the-College Luncheon, Barbeque, Alumni
Mixer, Banquet, Reunion Class Meeting, Opening and General Sessions, The T. S. Williams
Lecture, Exhibits, Refreshments, Proceedings; 20 C.E. hours)
Pre-Registration
$400 (Postmarked by 2-18-17)
Full Registration
$450 (Beginning 2-19-17)
(On-Site Registration Only after 3-4-17)
$__________________________
$__________________________
 Retired Alumni Registration
(Includes all activities: Scientific Sessions, State-of-the-College Luncheon, Barbeque, Alumni
Mixer, Banquet, Reunion Class Meeting, Opening and General Sessions, The T. S. Williams
Lecture, Exhibits, Refreshments, Proceedings, NO C.E. hours)
Pre-Registration
$200 (Postmarked by 2-18-17)
Full Registration
$250 (Beginning 2-19-16)
(On-Site Registration Only after 3-4-17)
$__________________________
$__________________________
 Graduate Student/Resident
(Includes all activities: Scientific Sessions, State-of-the-College Luncheon, Barbeque, Alumni
Mixer, Banquet, Reunion Class Meeting, Opening and General Sessions, The T. S. Williams
Lecture, Exhibits, Refreshments, Proceedings; 20 C.E. hours). Must attach written letter of
verification from Advisor.
Pre-Registration
$200 (Postmarked by 2-18-17)
Full Registration
$250 (Beginning 2-19-17)
(On-Site Registration Only after 3-4-17)




$__________________________
$__________________________
 Registration (One Day Only – Thursday, Friday or Saturday)
(Includes refreshments, proceedings, and meal on that day.)
Thursday, March 23, 2017 (8 C.E. hours)
$250
$___________________________
Friday, March 24, 2017 (8 C.E. hours)
$250
$___________________________
Saturday, March 25, 2017 (4 C.E. hours)
$150
$___________________________

CPR Lecture and Wet Lab
$150
Wednesday, March 22, 2017
Pre-Registration Required (Limited to 20 participants)
$___________________________

Complimentary Registration: TUCVM Class of 2016
(Includes up to 20 C.E. hours and Proceedings; NO Meals)
$___________NC____________
Complimentary Registration: TUCVM Faculty/Staff
(Includes up to 20 C.E. hours and Proceedings; NO Meals)
$___________NC____________
 SPECIAL EVENTS AND FEES
Banquet Ticket
#__________ @ $50 each
$___________________________
State-of-the-College Luncheon Ticket #__________ @ $40 each
$___________________________
Spouses Brunch
$___________________________
#__________ @ $20 each
Christian Veterinary Fellowship Breakfast
$__________NC_____________
Alumni Reception and Social Hour
$__________NC____________
 SPECIAL MEAL REQUEST:
Vegetarian (Banquet Only)
#___________
 DONATION (TU College of Veterinary Medicine – Tax Deductible)
GRAND TOTAL
$___________________________
$__________________________
PAYMENT METHODS:
1. Enclosed is my check/money order for $___________________ (Payable to Veterinary Medical Symposium)
2.
Please charge $_________________ to my: _____ VISA _____ Mastercard _____ Discover _____ American Express
Credit Card #_____________________________________________________________________ Exp. Date ________________________
Print Name: ___________________________________________________ Signature ___________________________________________
3-Digit Code (Back of Card) __________ Billing Address Zip Code ______________ Date Authorized ________________
4-Digit Code (Front of Card) _____________ (American Express Only)
Mail To:
Carrie King, Registration Coordinator
Veterinary Medical Symposium
College of Veterinary Medicine
Tuskegee University
Tuskegee, AL 36088
Phone: (334) 727-8470
Fax: (334) 724-4507
Email: [email protected]
Registration Fees Refundable If Cancelled By March 4, 2017
ON-SITE REGISTRATION ONLY AFTER MARCH 4, 2017