2017 Health Clinic Registration Form

This form is for registering your dog(s) for the health clinics to be held at the 2017 AWC National Specialty.
Note that we can accept checks or PayPal as payment for the clinics (you can use your credit card via PayPal).
You will be given a choice on your method of payment after you have filled out the registration form.
Enter your information here then click the "Final Review" button for confirmation and payment options.
My Information
First Name: 
Last Name: 
Address: 
City: 
State/Prov: 
Postal Code: 
Country: 
Phone: 
Email: 
RegistrationRegistration Information
Eye Testing (OFA):  # Dogs:  @ $30 each = $ 0
BAER Testing (use one line only)
BAER Testing - results released to WHF Database:  # Dogs:  @ $30 each = $ 0
BAER Testing - results remain confidential:  # Dogs:  @ $55 each = $ 0
Cardiac health clearance/pre-breeding ECHO exam (fill in the number of dogs)
Echocardiogram - results released to WHF Database: # Dogs:  @ $200 each = $ 0
Echocardiogram - results remain confidential: # Dogs:  @ $250 each = $ 0
   Select preferred day to have the cardiac Echocardiogram exam done:
(you will be contacted for appointment time)
AKC DNA Profile Testing:  # Dogs:  @ $40 each = $ 0
Microchipping:  # Dogs:  @ $35 each = $ 0
Total amount due:   $ 0
Click here to re-calculate if necessary
Additional Comments: 
You will get payment information 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.