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Laboratory Training Course Booking Form

Please complete all the fields below to place a booking for the two-day IDEXX Laboratory Training Course

*indicates required field.

First Name:*

Surname:*

VetCode:*

Practice Name:*

Post Code:*

Telephone:*

E-mail:*

Please indicate your preferred course date:

Course Dates 2010	Preference Ranking and Number Attending
12–13 January	first choice	second choice	third choice
	Number attending:
9–10 February	first choice	second choice	third choice
	Number attending:
9–10 March	first choice	second choice	third choice
	Number attending:
13–14 April	first choice	second choice	third choice
	Number attending:
11–12 May	first choice	second choice	third choice
	Number attending:
8–9 June	first choice	second choice	third choice
	Number attending:
6–7 July	first choice	second choice	third choice
	Number attending:
10–11 August	first choice	second choice	third choice
	Number attending:
7–8 September	first choice	second choice	third choice
	Number attending:
5–6 October	first choice	second choice	third choice
	Number attending:
9–10 November	first choice	second choice	third choice
	Number attending:
7–8 December	first choice	second choice	third choice
	Number attending:

Names of Applicants:

Comments:

I agree to the Terms and Conditions as specified by IDEXX Laboratories.