WDAVA CLINIC
ONLINE ENTRY

CLINIC SELECTION

CLINIC: *

Participant Name: *

Street Address: *

City *

State *

Zip *

Phone *

Email Address *

WDAA MEMBER ID:

Select your Clinic Day(s)*:

OCTOBER 7TH ($125.00) - MEMBER (Deposit: $62.50)

OCTOBER 8TH ($125.00) - MEMBER (Deposit: $62.50)

OCTOBER 7TH ($150.00) - NON-MEMBER (Deposit: $75.00)

OCTOBER 8TH ($150.00) - NON-MEMBER (Deposit: $75.00)

* Reserve your clinic reservation for 50% down, pay balance the day of the clinic* Checks made payable to WDAVA

Current Total:

$0.00