Thank you for participating in the AKC Veterinary Network. If you would like to terminate your practice's participation in the program, please complete the form below and provide an e-signature veryfying that you agree to the terms of terminating your participation.

Fields marked with an asterisk * are required.

AKC Veterinary Network Identifier Number	if available
First Name*
Middle Name
Last Name*
Your Title
Your Practice's Name*
Your Primary Telephone Number*	-   -   X
E-mail Address
Reason for terminating Participation*

By clicking this box, I understand that I am terminating my participation in the AKC Veterinary Network. After terminating my practice's participation, my practice will no longer be eligible to receive AKC Veterinary Network educational materials and my practice's contact information will be removed from the AKC website. I understand that my practice must honor AKC Veterinary Network certificates issued to clients before I submitted this request to opt out of the program. AKC Veterinary Network certificates are valid for 60 days from the date of the dog's registration, and the expiration date appears on the certificate.