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GOLDEN RETRIEVER CLUB
OF ALBERTA

EYE AND HEART CLINIC

October 14, 2012


Location:

Greenbank Veterinary Services
6710-101 Ave
Edmonton, Alberta

CERF Eye Exams
Dr. Graham Lewis D.V.M., Dipl ACVO

Cost:

GRCA Member

$37

Non Member

$42
Add'l dogs $37 (same owner)

AUSCULTATION Heart Clearance exams:
Dr Kim Hawkes D.V.M, Dipl ACVIM (Cardiology)


Cost:

GRCA Member

$45

Non Member

$55
Add'l dogs $50 (same owner)


As this is a one day clinic we cannot accept walk-in.
Registrations Close October 8, 2012 - no exceptions

Please make cheques payable to: The Golden Retriever Club of Alberta

NOTE: Post-dated cheques are not acceptable and we do not take Visa or Mastercard.

SCHEDULE: Sunday – Oct 14 – 8AM – 5:00 PM

You will be contacted either by phone or Email with your schedule the week of the clinic.


GOLDEN RETRIEVER CLUB OF ALBERTA
Heart and Eye Clinic
October 14, 2012

******* Please attach copy of CKC Registration to ensure accuracy *******

Please make cheques payable to: The Golden Retriever Club of Alberta

Payment MUST accompany your registration

Please send payment and registrations to:

Brenda Kenchington
8985 - 96 Avenue
Fort Saskatchewan, AB T8L 1E3
Email: pkenchi1@telusplanet.net

Please make as many copies as you need.

PLEASE PRINT CLEARLY

Owner’s Information

Last Name:_________________________ First Name: ____________________

Address:________________________________ City:______________________

Prov: _____ Postal Code _____________ Phone #_________________________

Email: ______________________________________

Appt Time of Day: Morning ____ or Afternoon ___

DOG

Please check clinics requested: Heart
____ Eye ____

Call Name:_____________________

Reg. Name:___________________________________________

CKC Reg. Number: ________________Tattoo/Microchip#_____________

DOB: _________________________ ( eg: 25-Jul-2011)

Sex: Male or Female (please circle)

Breed: ___________________

Coat Color/Type _______________________

Has this dog attend a previous GRCA Clinic? If yes, what year: ______

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