CERF CLINIC

Sponsored by the Kokomo Kennel Club
Saturday, May 21, 2011



Conducted by Board Certified Ophthalmologist, Dr. Sheryl Krohne, School Of Veterinary Medicine, Purdue University

The CERF Clinic will be held on the Show Grounds in the Office Building with the cost of the exam being $23.00 if you Pre- Registration and $25.00 the day of the Clinic.

All dogs will need eye drops applied 20 minutes before there exam so there eyes can dilate.

Dogs will be seen on a first come first serve basis on Saturday May 22, 2011 from 10:00 A.M. to 4:00 P.M.

Pre-Registration is encouraged; however we will gladly accept Walk Ins.

Please bring your dogs AKC papers or if you don't have them you will need to provide the dogs AKC numbers on your registration form.

 Kim Simcox
1548 W 300 S
Peru, IN 46970

If you have any questions feel free to contact me at
(765) 473-5376 or Kim_Simcox@yahoo.com
 

ALL PRE-PAY FEES AND FORMS MUST BE
RECEIVED BY MAY 13, 2011
(No Refunds and There will be a $ 50.00 service fee for all Returned Checks)

 

OWNER’S NAME _____________________________________

ADDRESS __________________________________________

PHONE ________________ EMAIL _____________________

DRIVERS LICENSE # NUMBER__________________________

DOG’S REGISTERED NAME _____________________________

DOG’S CALL NAME ___________________________________

BREED/VARIETY ____________________________________

COLOR ____________________ SEX ____________________

BIRTHDATE _______________ AKC# ____________________

TATTOO/MICROCHIP# ______________________________
 

Print this page, fill it out and send it with a check for $23 to:

 Kim Simcox
1548 W 300 S
Peru, IN 46970