Registration for Individuals Beginning Training
City, State, Zip *
Daytime Phone Number*
E-mail Address *
Which option describes how you intend to become qualified by training. This question is required. *
Conforming Residency Program
Non-Conforming Residency Program
You chose the 'Non-Conforming Residency Program'. Please list who your mentor will be.
You chose the 'Conforming Residency Program'. Please list what program you are currently enrolled in.
Upload the letter from your supervising or mentoring ACVB Diplomate here/ Upload the letter from your supervising or mentoring ACVB Diplomate here.
A $103 fee (United States funds) is also required along with this completed online form. This fee will include evaluation of the first submission of the description of a training program which is not a conforming residency. Unsuccessful non-conforming programs will require additional fees ($77) when submitted.
Payments can be made via paper check or online (
Please mail all checks to the following address. In the 'Memo' line please list "Training Registration Fee".
5003 SW 41st Blvd.
Gainesville, FL 32608
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