Raleigh!

Symposium 2009
REGISTRATION

Join us

Jan 30 - Feb 1

This online registration form is for the convenience of our members. Since we are not equipped to accept payment online, confirmation and payment will be by regular mail. Complete and print the form below and then mail both pages of the form and your check to WRNC, c/o Jean Chamberlain, 1868 Rierson Rd., Tobaccoville, NC 27050.  If you wish to qualify for "early bird" rates, the registration form and payment must be postmarked by the cut-off date of January 12, 2009.

Payment Schedule
 
Postmarked by Jan 12
Postmarked after Jan 12

Registration for Non-member
$60
$70
Registration & 2009 Membership
$60
$70
Name: Address:
City/Town: State: Zip Code:
Telephone: E-mail Address:
Do you plan to attend the banquet (no additional charge)? Yes    No
Additional banquet guests ($28.00 each)? Yes No    How many?
Do you plan to attend the IceBreaker Friday evening? Yes    No
Do you plan to take the beginner track? Yes    No
Do you plan to attend the fawn session on Friday? Yes    No
Check those workshops that you wish to register for. Pre-registration is required for the workshops. You will receive separate confirmation of your place in the workshop(s) by email. Be sure you have provided an email address above.
Mammal Physical Exam     Sub-q Fluids     Avian Physical Exam     Fecals     Mammal Bandaging/Splinting
Note: Those taking the beginner track should register for both the mammal physical exam and sub-q workshops.
Complete this section if you are a vet tech or vet office staff member.
Clinic:
Clinic Phone:
Do you wish to receive vet tech CE credit for the sessions you attend?    Yes   No
Complete this section if you want to be a member for 2009.
The membership fee of $15 is included in the $60 registration..
Home Phone: County:
Work Phone: District (if known):
Organization/Center (if applicable):  
Are you a new member or are you renewing your membership?   New    Renewing
WRNC publishes a membership directory. It enables us to refer callers to one another or seek help if we need it.
Answer the remaining questions if you wish to be listed in the membership directory.
Do you have a current state rehabilitation permit?      Yes     No
Do you have a current federal rehabilitation permit?     Yes     No    ( If yes, please include a copy)
Do you work out of a center or independently at your home?
Do you have a membership in the International Wildlife Rehabilitation Council (IWRC), the National Wildlife Rehabilitators Association (NWRA), or any other state or local rehabilitation groups? Please list:
How long have you been rehabilitating?
Which groups of animals do you rehabilitate? Check all that apply and write in exceptions, if any. 
    Small mammals including opossums
    Mid-size mammals (river otter, bobcat, beaver, woodchuck)
    Songbirds     Seabirds     Raptors     Wading Birds     Waterfowl
Note: you must have a federal permit or be a subpermittee on someone else's permit to be listed as accepting birds. You must  send a copy of the permit to be listed.
    Reptiles/Amphibians       If yes, do you accept venomous snakes?     Yes No
WRNC t-shirts will be available for sale at the symposium for $12.
 
This form is 2 pages long. Please print and send both pages.
 
Please do not bring any wildlife to the symposium.
Thank You. We look forward to meeting you at the symposium.