Sessions will be offered via live stream. Please, check the appropriate box when registering so we know if you plan to attend online or in-person. Lewis and Clark Meeting | Pre-Registration Form LEWIS AND CLARK VETERINARY MEETING SPONSORED BY: INTERSTATE VETERINARY MEDICAL ASSOCIATION South Sioux City Marriott Riverfront South Sioux City, NE How Many?EventPre-Regristration CostSub-TotalLarge Animal (Thurs. & Fri.)Small Animal (Wed. & Thurs.)Small Animal (Wed.Only)Large & Small Sessions2023 Vet GraduatesTechnicianSmall Animal (Wednesday Evening Only)Technician Session (Wednesday only)BRONZE Sponsorship $150SILVER Sponsorship $500GOLD Sponsorship $750Large AnimalQuantityEvent Large Animal Registration CostSub-TotalSmall Animal (Wed. & Thurs.)QuantityEvent Small Animal Registration CostSub-TotalSmall Animal (Wed. Only)QuantityEvent Small Animal (Wed. Only)Registration CostSub-TotalLarge & Small SessionsQuantityEvent Large & Small SessionsRegistration CostSub-Total2023 Vet GraduatesQuantityEvent 2023 Vet GraduatesRegistration CostSub-TotalTechnicianQuantityEvent TechnicianRegistration CostSub-TotalSmall Animal Session (Wednesday Evening Only)QuantityEvent Small Animal Session (Wednesday Evening Only)Registration CostSub-TotalTechnician Session (Wednesday Evening only)QuantityEvent Technician Session (Wednesday Evening only)Registration CostSub-TotalBronze SponsorshipQuantityEvent Bronze SponsorshipDoor CostSub-TotalSilver SponsorshipQuantityEvent Silver SponsorshipDoor CostSub-TotalGold SponsorshipQuantityEvent Gold SponsorshipDoor CostSub-TotalOther SponsorshipOther SponsorshipQuantityEvent Other SponsorshipMSO Sub-TotalSub-TotalSection BreakEmail* Clinic or Company Name* Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Spouse's Name First Last Doctor's Names - separate by commas Technician's Names - separate by commas How will you attend?* Online Attendance Only In-Person Attendance How will you pay?* I will be paying by PayPal I will be sending a check to: 19524 460th Street, Havelock, IA 50546 Payment MethodPayPal Checkout American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Total $0.00
