Asheboro!

Symposium 2007
REGISTRATION

Join us

Jan 26 - Jan 28
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 the form and your check to WRNC, c/o Carla Johnson,
2542 Weymoth Rd., Winston-Salem, NC 27103.  If you wish to qualify for "early bird" rates, the envelope with the registrations form and payment must be received by the cut-off date of January 8, 2007.

Payment Schedule
 
Rec'd by Jan 8
Rec'd after Jan 8

Registration for Non-member
$40
$50
Registration & 2007 Membership
$40
$50
Registration and Banquet
$53.50
$63.50
Name: Address:
City/Town: State: Zip Code:
Telephone: E-mail Address:
Do you wish to attend the banquet ($13.50)?................... Yes    No
Additional banquet guests ($13.50 each)? ........................ Yes No    How many? _____
Do you wish to sign up for the cage building workshop ($15 per cage)?.......... Yes    No
Do you wish to attend the federal permit course?............... Yes    No
Do you plan to attend the IceBreaker Friday evening?............ Yes    No
Check those workshops that you are interested in attending:  
Mammal Necropsy
Avian Necropsy
Cage Building
 Turtle Shell Repair
Bandaging & Wound Management

 Dosage Calculations
Physical Exam
Sub-q Fluids
Complete this section if you are paying your membership fee with your registration.
The membership fee of $15 is included in the $40 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. Do you want to be listed in the membership directory? Yes   No
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
Wildlife is not permitted in the Education Building. Please do not bring any wildlife to the symposium.
Thank You. We look forward to meeting you at the symposium.