Pet Service Payroll Deduction Authorization Form - Partner Veterinary Urgent Care

Please review the steps below to ensure the payroll deduction for your pet service

Your Manager *

Name *

First

Last

Date of Request *

Registration Cost *

Conference Dates

Conference Start Date *

Conference End Date *

Checkboxes

I would like Partner Veterinary to make the initial payment for the conference on my behalf
I will enroll and pay for the conference application myself and submit an expense for reimbursement

Brief description of lectures that will be attended and learning objectives: *

Checkboxes (copy) *

In the event I separate employment with Partner prior to the CE event, and the event expenses were prepaid or reimbursed; the amount of the CE expenses will be deducted from the final paycheck.

Layout

Signature *

*By typing your name above you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Date *

Partner Veterinary Urgent Care

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