Figure 2

Web-based application format

Record keeping was very quickly identified as a limiting aspect of list management. The need to carefully screen subscribers yet quickly add people to the list led us to find a way to automate the process. A web form application is quick and convenient for subscribers. It also ensures that applicants provide all necessary data, and that the data are organized in a consistent format. The automatic insertion of < tab > characters between record fields allows for rapid import into a database.


Sample form only
Go to here for the real form

Vetplus-l Application Form

Best viewed with:

Have you read the vetplus charter yet? If not, please go here to view it before submitting this application.

Full name
First name and middle initial (i.e. John M.):
Last name:

Date of birth (MM/DD/YY) [optional]:

Sex

Education
Degree 1 (leave blank if none)
Degree 2 (leave blank if none)
Degree 3 (leave blank if none)

E-mail address(es):
Primary address (to which vetplus-l messages will be sent)
Other addresses (which the list will accept mail from; if more than one, please separate addresses with a space) [optional]:

*if vet student, please be sure to submit your official .edu address to us.

Postal address
line 1 *clinic or company name, as applicable
line 2
City, state/province/county
country Postal code

Telephone Work
Home [optional]
Fax [optional]


Job description: (i.e. owner/veterinarian, associate veterinarian, vet student, professor, etc.)

Employer (i.e. self, Hill Veterinary Practice, etc. If a vet tech or vet nurse, please list the veterinarian who most closely supervises your work.)
Employment status


Professional organization 1 (i.e. AVMA, Uganda Veterinary Association)

Professional organization 2
Professional organization 3

Special interest 1
Special interest 2
Special interest 3

Computer type (check all that apply)
Mac
PC
Unix flavor
Amiga
Other (sorry VMS users)
Unknown
Communications link for e-mail (choose option you believe best describes your setup)


Please list any additional information you'd like considered:


Expect to hear from Jeff Parke or Allan Berger during the next couple of days. If you don't hear from us soon, please contact one of us by e-mail.

Sample form only
Go to here for the real form


Go on to Figure 3
Go back to the Contents


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