R.F. Redden, DVM
In-Depth Short Course Registration Form

Please type in all information below and fax or mail to R.F. Redden, DVM. Name: Address: City:  State:   Zip:  Country: Email: Phone:  Fax: Check one of the following: DVM Farrier Owner   Farm Manager  Student  Other NOTE: If registering more than one person, please submit information on separate sheets. Description Price Total 2 1/2 Day Lecture Fee (Postmarked on or before May, 1 2007) $450.00 $ 2 1/2 Day Lecture Fee (Postmarked after May 1, 2007) $500.00 $ Student Rate Lecture Fee (ID required on school letterhead) $350.00 $ 1 Day Lecture Fee, Check day attending: Jun 1 2 3 $300.00 $ NOTE: POSTMARK STRICTLY ENFORCED!                                   TOTAL AMOUNT $ PAYMENT TYPE:  Must be in US Funds   Credit Card   Check**   Money Order ** Make checks payable to R.F. Redden, DVM. 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, MC, & 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@att.net Mail form to: R.F. Redden, DVM PO Box 507 Versailles, KY 40383