NAME:_______________________________________________________________

                

  STREET:_____________________________________________________________

  CITY:__________________________ STATE:_____________ ZIP:____________

  PHONE:____________________ EMAIL: __________________________________ 

  Please email me the report _____

  EERF RESEARCH REPORT - Please choose the breed of interest:
       ____Kentucky Mountain Saddle Horse          
       ____Mountain Pleasure Horse                 
       ____Palomino                                
       ____Pinto                                   
       ____Quarter Horse                           
       ____Rocky Mountain Horse                    
       ____Spanish Mustang                         
       ____Trakehner                               
       ____Tennessee Walking Horse                 

       _____  $5.00 EERF research report for one breed
       _____  $5.00 EERF registration report (all breeds)
       _____ $20.00 VMDB report for one breed, top 100 diagnoses, age/sex breakdowns
       _____ $20.00 VMDB report for all breeds, top 100 diagnoses, age/sex breakdowns
___________________________________________________________________________________________



  Check_______  Visa _______  Mastercard _______  Expires ________/_______



  (payable to EERF)   Number _____________-_________-__________-__________



  SIGNATURE_______________________________________________________________

        SEND:                           TO:

        Completed Form                  Purdue University                    Phone:765-494-8179

        Check, money order (US funds)   Equine Eye Registration Foundation   FAX:  765-494-9981

        OR include credit card          EERF/Lynn Hall 
        information                     625 Harrison Street 
                                        WEST LAFAYETTE, IN 47907-2026

© 2002 Equine Eye Registration Foundation. All rights reserved.