2020 Cardiac Clinic Registration Form

This form is for registering your dog(s) for the cardiac clinics to be held this October in Wisconsin.
You must pre-register and pay online via PayPal (you can use your credit card via PayPal).
Click here for more information.
Enter your information here then click the "Final Review" button for confirmation and PayPal payment.
My Information
First Name: 
Last Name: 
Address: 
City: 
State/Prov: 
Postal Code: 
Country: 
Phone: 
Email: 
RegistrationRegistration Information
Cardiac health clearance/pre-breeding ECHO exam (fill in the number of dogs)
Echocardiogram (Whippet) - results released to WHF Database: # Dogs:  @ $225 each = $ 0
Echocardiogram (Whippet) - results remain confidential: # Dogs:  @ $275 each = $ 0
Echocardiogram - dogs other than Whippets: # Dogs:  @ $300 each = $ 0
   Select preferred day to have the cardiac Echocardiogram exam done:
 (you will be contacted for appointment time)
I could make the overflow date of Tuesday, October 13 
Total amount due:   $ 0
Click here to re-calculate if necessary
Additional Comments: 
You will get a payment link after clicking on the "Final Review" button below.
  Please direct any questions or comments about this form to Dr. Lisa Costello at mtncow@earthlink.net.