HEALTH CLINICS
Saturday, March 12, 2011 9:00 am - to 4:00 pm
Open to all breeds
Heart Clinic Registration Form
Dr. Tacy Rupp
Cost:
$50.00 - Ascultation
$165.00 - Echocardiograms
Type of Test: _____ Ascultation _____ Echocardiograms
Name of Dog _____________________________________________________
Breed ___________________________________________________________
Owner 's Name ___________________________________________________
Street Address ____________________________________________________
City/State /Zip ____________________________________________________
Phone Number ___________________________________________________
E-mail __________________________________________________________
Pre-entries only for Echocardiograms
CERF Clinic Registration Form
Dr. Susan Carastro
Dr. Joshua Broadwater
Cost: $40.00
Name of Dog _____________________________________________________
Breed ___________________________________________________________
Owner 's Name ____________________________________________________
Street Address ____________________________________________________
City/State /Zip _____________________________________________________
Phone Number ____________________________________________________
E-mail ___________________________________________________________
Preferred time: _________________ am _________________ pm
Make checks payable to:
PBCDFA
Mail to:
Hilton Palm Beach Airport
Attention: Michelle Conroy, Dog Club
150 Australian Avenue
West Palm Beach, FL 33406
(706) 781-3051
or
(561) 400-2567
APPOINTMENTS WILL BE TAKEN DAY OF
SHOW IF ANY SPOTS STILL AVAILABLE