Submission Form

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Form A- Vets in Practice/Humane Society/Animal Care

Form B- Vets in Education/Research/Government/Diagnostics/Other




Form A -Veterinarians in Animal/Pet Care

Please fill in the following information:
.


Veterinarian or Hospital:
(28 chars or less including spaces)


Address:

City:

County or Region:

State or Province:

Country:

Zip code or Postal code:

Ph. or tel.#:


Select one for each category:

DOGS yes no limited

CATS yes no limited

BIRDS yes no limited

FERRETS yes no limited

RABBITS yes no limited

POCKET PETS yes no limited

EXOTIC PETS yes no limited

REPTILES yes no limited

FISH yes no limited

HORSES yes no limited

FARM ANIMALS yes no limited

WILDLIFE-ZOO yes no limited

MARINE MAMMALS yes no limited

ACUPUNCTURE yes no limited

ALTERNATIVE yes no limited

HOLISTIC yes no limited

TRADITIONAL yes no limited

BOARD CERTIFIED SPECIALIST yes no

BOARDING yes no limited

GROOMING yes no limited

OBEDIENCE TRAINING yes no limited

HOUSE CALLS yes no limited

AFTER HOURS EMERGENCY yes no limited


FIELD OF WORK
Practitioner
Humane Society
Other (please specify)

COMPANY,PRACTICE or GROUP
(when 5 colleagues list from your same group & region, a new indexed page will be created for them)

WEBSITE URL

EMAIL where you want to direct pet owners.

EMAIL where you want us to contact you (Required).



Additional Descriptive Line1 Option:
(33 characters or less including spaces)

Additional Descriptive Line2 Option:
(33 characters or less including spaces)

Statement of Doctorate, Agreement and Positioning!

You have read, understand and accept the above statement: YES





Form B -Veterinarians in Non-Practice

Please fill in the following information:
.


Veterinarian:
(28 chars or less including spaces)


Address:

City:

County or Region:

State or Province:

Country:

Zip code or Postal code:

Ph. or tel.#:


Select all that apply:

FIELD OF WORK
Clinical Practice
Education
Diagnostics
Research & Development
Zoological Park
Government
Pharmaceutical / Biological
Corporate
Nutritional
Field Studies
Technical Writing
Technical Sales
Inspection
Administrative / Management
Legislative
Public Relations
Other (please specify)


Select one from each category:

ANATOMY / PHYSIOLOGY yes no limited

ANESTHESIOLOGY / SURGERY yes no limited

ANIMAL BEHAVIOR yes no limited

ALTERNATIVE MEDICINE yes no limited

BIOCHEMISTRY yes no limited

CARDIOLOGY yes no limited

DENTISTRY yes no limited

DERMATOLOGY yes no limited

EMERGENCY & CRITICAL CARE yes no limited

EPIDEMIOLOGY yes no limited

GENERAL MEDICINE yes no limited

INTERNAL MEDICINE yes no limited

MICROBIOLOGY yes no limited

NEUROLOGY yes no limited

NUTRITION yes no limited

ONCOLOGY yes no limited

OPHTHALMOLOGY yes no limited

PARASITOLOGY yes no limited

PATHOLOGY yes no limited

PHARMACOLOGY / TOXICOLOGY yes no limited

RADIOLOGY yes no limited

THERIOGENLOGY yes no limited

OTHER yes no limited


Select all that apply:

SPECIES CODE
Avian
Bovine
Canine
Rodents
Equine
Feline
Humans
Marine Mammals
Primates
Aquatic Animals
Reptiles / Amphibians
Porcine
Exotics
Zoo Animals
Other (please specify)

UNIVERSITY,COMPANY,PRACTICE or GROUP
(when 5 colleagues list from your same group & region, a new indexed page will be created for them)

WEBSITE URL

EMAIL where you want to direct visitors.

EMAIL where you want us to contact you (Required).



Additional Descriptive Line1 Option:
(33 characters or less including spaces)

Additional Descriptive Line2 Option:
(33 characters or less including spaces)

Statement of Doctorate, Agreement and Positioning!

You have read, understand and accept the above statement: YES