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Registration Form

ANHC Education Programs
Professional Course in Veterinary Homeopathy 2008-2009

Name * First Last
What is your degree? * DVM VMD Foreign veterinary degree
You must be a licensed veterinarian to participate in this course. Please indicate your degree.
Year of degree & school attended. *

Enter the year you received your degree and what school it was obtained from. If a foreign (non-US) degree, also indicate what degree you received.
Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone at work * - (###) - ### ####
If you work out of your home, then enter that number.
Phone at home * - (###) - ### ####
Or your preferred contact number.
Mobile Phone - (###) - ### ####
If you have one, please enter the information.
Which of these numbers is best to use? * work number. home number. mobile number.
Helps me to know how to reach you.
Email

My preferred means of communication is email, so if you have one, be sure to enter it here.
Web Site

If you have one.
What is your prior experience with homeopathy?

If you have studied homeopathy before, or used it in your practice, please describe your experience here.
How did you hear about this course? From a colleague. Searching the internet, Google, etc. From the Academy of Veterinary Homeopathy. Dr. Pitcairn's web site. From a client. From a journal or newsletter. Other.
If you selected "other", briefly explain how you came to know of this course.

Helps me to know how to get the word out.
Tuition payment method * $4375 by check. $4500 by credit card $2300 now, balance of 2300 Nov. 1, 2008.
If by check, send to ANHC Education Programs, 1865 Gun Fury, Sedona, AZ 86336.
If by credit card, for security purposes, fax your credit card number, expiration date, the name on your card and address for billing if different than what you are entering on this form — to (866) 274-7307.
The option of 2 payments can be done with either check or credit card.
If by check or credit card — I will fax it to you (866) 274-7307. I will mail the information to — ANHC Education Programs, 1865 Gun Fury, Sedona, AZ 86336. I will be calling it in by phone to (541) 520-1891 (Mountain time).
So I know what to expect.
Do Not Fill This Out