SonoPath Imaging Center Dinner & Lecture Registration Form

Registration for SonoPath & Zoetis: SonoPath Imaging Center Dinner Lecture, March 30, 2023

"*" indicates required fields

Email*

First Name*

Last Name*

Corporate Affiliation*

If you do not have a corporate affiliation, just type none.

Professional Code*

(Use the following profession codes for this board: Veterinarian=V; Veterinarian Technician=VT) SELECT FROM DROPDOWN.

Veterinary Credentials*

Hospital/Clinic Name*

Address*

City*

State*

Postal Code*

Mobile Phone Number*

Buffet Dinner menu

The Buffet Dinner Menu includes: - Mixed Green Salad - Pappardelle with wild mushrooms, pistachio and sage - Sea Bass, pancetta, red wine peppercorn butter, charred broccoli rabe, eggplant caviar - Slow roasted pork shoulder, grilled fennel, potato rocks, rosemary jus.

Do you have any dietary restrictions?*

Yes

If yes, please let us know what your dietary restrictions are below:*

Please refer to menu above.

How many guests will be attending with you from your hospital/clinic?*

1 - myself only

2 - myself and a colleague

Seating is limited and we are requesting only 2 from the same clinic/hospital to attend. We can add additional names to a wait list incase of any cancelations.

Please include the name of your colleague and if they have any dietary restrictions.

Please refer to menu above.

Anything else you'd like to let us know? Any Questions?