CE Mail List

KSUCVM • Continuing Education • Mailing List Form

KSU College of Veterinary Medicine
Continuing Education Mail List Update

First Name
Last Name
Middle Name or Initial
Street Address (Line 1)
Street Address (Line 2)
City
State		(OO - other)
Zip
Business/Clinic Name
Business Phone Number		- - ext.
Home Phone Number		- -
Fax Number		- -
E-mail Address
Please Check One:
DVM
If DVM, Received DVM From
Year of Graduation
Veterinary Technician
Clinic Support Staff
Other
If other, please list (i.e pharmaceutical rep. student)

My main conference interest(s) is (are):
Small Animal		Bovine/Food Animal
Small Ruminant		Equine
Exotics		Other, please List

I have internet access	I wish to receive email
I wish to receive land mails	I have computer at clinic
I can communicate through emails at clinic

K-State Website • KSUCVM Mainpage • Continuing Education Mainpage