Veterinary Therapeutics for Companion Animals REGISTRATION FORM Veterinary Therapeutics for Companion Animals list of Courses □ Lecture 1: The Veterinary Profession, Dosage Forms and Veterinary Client Counseling (0.25 hrs)……………………… □ Lecture 2: Dosage Determination in Veterinary Medicine (0.25 hrs)…………………………………………………………. □ Lecture 3: Internal Medicine (1.25 hrs)………………………………………………………………………………………….. □ Lecture 4: Poisoning and Toxicology (0.25 hrs)………………………………………………………………………………… □ Lecture 5: Zoonoses: Human and Animal Relationships in Health (0.25 hrs)………………………………………………. □ Lecture 6: Contemporary Pain Management in Companion Animals (0.5 hrs) ……………………………………………. □ Lecture 7: Sedation, Anesthesia and Behavior Management (0.5 hrs)…………………………………………………….. $10 $10 $50 $10 $10 $20 $20 □ Lecture 8: Parasites and Antiparasitic Therapy (2.5 hrs)…………………………………………………………………….. □ Lecture 9: Dermatology, Topical Therapies and Related Endocrine Disorders (1.25 hrs)……………………………….. □ Lecture 10: Antibiotic Therapy in Companion Animals (0.5 hrs)…………………………………………………………….. □ Lecture 11: Veterinary Pharmacy Law: Regulatory Update (0.5 hrs)……………………………………………………… $100 $50 $20 $20 □ Lecture Series (All 11 Lectures (8.0 hrs)……………………………………………………………………………………... $300 Name: __________________________________________________________________________________________________ Telephone No. ___________________________________________________ Email address _____________________________________________________________________________________________ *An email address is required to receive confirmation materials. You will receive emails from ceadmin@pharmacy.wisc.edu. Address _________________________________________________________________________________________________ City, State Zip _____________________________________________________________________________________________ Three ways to register: 1. Mail this registration form with a check (payable in US funds) to the address below. 2. By phone at (608) 262-3132 or toll free at (877) 947-4255 with a credit card. 3. Fax the registration form to (608) 262-2431 with credit card information. Mail, in the full amount, a check made payable to University of Wisconsin. UW-Madison School of Pharmacy Division of Pharmacy Professional Development 777 Highland Avenue Madison, WI 53705 For course information call: Ruth Bruskiewitz at (608) 265-8249 ruth.bruskiewitz@wisc.edu Credit card information (MasterCard, Visa, Discover, and American Express) Cardholder’s Name ____________________________________________________________ Card Number __________________________________________________________________ Expiration Date ______________________________