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REGISTRATION FORM
NEW JERSEY VETERINARY MEDICAL ASSOCIATION
121st ANNUAL MEETING
Dolce Hamilton Park Conference Center,
Florham Park, NEW JERSEY
MARCH 4-6, 2005

Important Information: We encourage you to bring your spouse, family and friends to our Annual Meeting. These guests are not, however, allowed to attend lectures and technical sessions unless they pay full registration fees. Guest registration covers social events, Saturday reception and coffee breaks. Guests are cordially invited to also register for the Animal Hall of Fame luncheon.
Please note that the Animal Hall of Fame luncheon is not included with your registration this year. If you wish to attend the Animal Hall of Fame luncheon, you must indicate so on this form and remit the additional fee.

If you are interested in attending this event please fill out the form below, print and fax to the New Jersey Veterinary Medical Association:
Fax: 973-379-6507

First Name

Last Name

Hospital Name

City

Address

State Zip Code

Phone
- -

Fax
- -

E-mail

On or Before
February 20
(per person)
After
February 20
(per person)
NJVMA Members and Out-of-State VMA Members
Entire Meeting, includes March 5th dinner and entertainment  
$210.00
$240.00

Per Day, includes NJVMA luncheon March 5th
$140.00
$165.00

does not include Hall of Fame luncheon March 6th
$130.00
$155.00

2003 Graduates and Emeritus Members
Entire Meeting, includes March 5th dinner and entertainment  
$130.00
$140.00

Per Day, includes NJVMA luncheon March 5th
$85.00
$95.00

does not include Hall of Fame luncheon March 6th
$75.00
$85.00

Non-Members
If registration is accompanied by a valid
NJVMA membership application, registration
fee is the same as the member's fee.

 
Entire Meeting, includes March 5th dinner and entertainment  
$265.00
$300.00

Per Day, includes NJVMA luncheon March 5th
$160.00
$185.00

does not include Hall of Fame luncheon March 6th
$130.00
$155.00

Technicians, Office Staff and Farriers

Entire Meeting, includes March 5th dinner and entertainment  
$110.00
$135.00

Per Day, includes NJVMA luncheon March 5th
$70.00
$85.00

does not include Hall of Fame luncheon March 6th
$60.00
$75.00

Veterinary School and Veterinary Technician Students

Entire Meeting, no meal functions  
$20.00
$30.00

Per day, no meal function  
$15.00
$20.00

Guests

Includes President's Reception, coffee breaks
Saturday Reception, Saturday NJVMA Luncheon and Sunday Breakfast
(Saturday dinner is not included)		  
$65.00
$75.00

Special Events

March 5th Dinner and Mardi Gras Casino  
$55.00
$60.00

Animal Hall of Fame Luncheon  
$39.00
$44.00

Total charges from Child Care Registration form _________________________

Total registration charges                                    _________________________

New Jersey Veterinary Foundation tax-deductible contribution

$10.00 $25.00 $50.00 $100.00

Check enclosed or Charge to my credit card
(Check one) Visa MasterCard AMEX

No.__________________________________ Exp. Date_____________________

Signature __________________________________________________________

Name on credit card: ________________________________________________

Credit Card Billing Address: __________________________________________

Please make check payable to 'NJVMA" and mail to: NJVMA, 66 Morris Ave., Suite 2A, Springfield, NJ 0708 1. Refund Policy Full refund of registration fees if request is received by February 20, 2005. A $30.00 fee will be charged to cover printing and other administrative costs for all refund requests received after February 20, 2005.


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