2019 Blue River PetCare Annual Conference Registration

Please complete the survey below to register for our 2019 Annual Conference. If you have additional requests or questions, please feel free to reach out to Amy Jackson at ajackson@brplp.com or at 312.637.1811.

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* 1. Please enter your personal contact information below.

Hospital/Clinic Name

Name

Email Address

Cell Phone Number

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* 2. Please list an emergency contact.

Name

Relationship to you

Phone Number

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* 3. Please provide your arrival information below.

Arrival Date

Estimated Arrival Time

Airline & Flight Number

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* 4. Please provide your departure information below. Note: If you will be departing Saturday or Sunday, please also note that in the "Other Comments" box at the end of the survey.

Departure Date

Departure Time

Airline & Flight Number

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* 5. Please list any dietary concerns or restrictions.

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* 6. Please list any meeting space accommodation requests.

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* 7. Please list any hotel accommodation requests (including bed type requests). PLEASE NOTE: Bed Type requests are NOT guaranteed, but we will do our best to work with the conference hotel to accommodate.

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* 8. Please tell us your preferred name for your name badge.

Name

Title (DVM, RVT, CVT, CVPM etc.)

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* 9. Please provide your tshirt size (T-shirt will be Unisex).

2XL

3XL

4XL

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* 10. Will you be attending the Wednesday Welcome Reception? Reception will be from 6-8pm at Jake Melnick's Corner Tap (4 blocks from hotel). Stay as little or as long as you wish. Drinks, wings, appetizers and BBQ will be served.

Yes, I will attend.

Yes, I will attend, and I will have a guest.

No, I will not attend.

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* 11. Other Comments: Please feel free to provide any additional information you wish to provide, or contact Amy Jackson either by email at ajackson@brplp.com or by phone at 312.637.1811. Thank you for registering!