Application
NAME:
 PERSON TO CONTACT IN CASE OF EMERGENCY:
MALE:    FEMALE ADDRESS:
ADDRESS:
 PHONE NUMBER:
COUNTRY:
 		FOOD OR MEDICATION ALLERGIES:
TEL NO:

NAME OF VETERINARY SCHOOL:

FAX NO:

YEAR IN VETERINARY SCHOOL or YEAR GRADUATED:
E-MAIL:
 		  
COURSE DATES

ARE YOU A VEGETARIAN?

Contact Person:
Ane-lize du Plessis
Portfolio Coordinator
Continuing Education at University of Pretoria
Tel:  (012) 420 5862
Fax: (012) 362 5285
E Mail: anelize.ce@up.ac.za

NOTE:
 Do not travel without an epinephrine pen/kit and other appropriate allergy medicines if you have known potentially  anaphylactic type allergies such as insect stings.