2018 Health Clinic Registration Form

This form is for registering your dog(s) for the health clinics to be held at the 2018 AWC National Specialty.
Note that online registration is only available if you are paying via PayPal (you can use your credit card via PayPal).
If you are paying by check, you will need to fill out a printed registration form and send it in along with your check.
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
Eye Testing (OFA):  # Dogs:  @ $35 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 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.