International Equine Podiatry Center

Dr Redden's Equine Podiatry 101 Course Registration Form

Please type in all information below and fax/mail to IEPC. Name: Address: City:  State:   Zip:  Country: Email: Phone:  Fax: Check one of the following: DVM Farrier NOTE: If registering more than one person, please submit information on separate sheets. Description Price Total 5 Day Equine Podiatry 101 Fee (Aug 9 - 13, 2010) $2850.00 $ PAYMENT TYPE:  Must be in US Funds   Credit Card   Check**   Money Order ** Make checks payable to IEPC. CREDIT CARD PAYMENT INFORMATION: TYPE OF CARD:   Visa   MasterCard   American Express   Discover   Diner's Card CARD NUMBER: *Please Include 3 digit code on back for Visa, Mastercard, & Discover or 4 digits on the front for AMEX* EXP. DATE CARDHOLDER'S NAME AS IT APPEARS ON THE CARD: CARDHOLDER'S SIGNATURE: X  Fax form to: (859) 873-6589 Phone: (859) 873-5294 Email: reddendvm@windstream.net Mail form to: IEPC PO Box 507 Versailles, KY 40383