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Maryland
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Association FIND AN MVMA VETERINARIAN Doctor's Name Practice Name City State (use two character abbreviation such as MD) Zip Code SEARCH THE MVMA WEB SITE Search our site with Enter your search terms Web mdvma.org MVMA Membership Application Please complete the following form and click the submit button to apply for membership in the Maryland Veterinary Medical Association. This application must be accompanied by the full membership dues for the first year. To download a printable application to return by fax or U.S. Mail, click here. Academic Membership Dues $80/year Academic membership shall consist of graduates of a College of Veterinary Medicine who are employed by academic veterinary medical institutions and who are not in private practice. Academic members may not vote or hold office, but otherwise shall have all the privileges of active members. Academic veterinarians wishing to have voting rights may instead select apply for regular membership. First Name MI Last Name Position/Title Employer Office Address City State Zip County Allegany County Anne Arundel County Baltimore City Baltimore County Calvert County Caroline County Carroll County Cecil County Charles County Dorchester County Frederick County Garrett County Harford County Howard County Kent County Montgomery County Prince George's County Queen Anne's County St. Mary's County Somerset County Talbot County Washington County Wicomico County Worcester County Home Address City State Zip Which address do you wish to appear in the directory? Home Office Office Phone Home Phone Fax Mobile Phone Business E-mail Personal E-mail Undergraduate School Year Degree Veterinary School Year Degree(s) Date of Birth City State Marital Status Single Married Spouse's Name Board Certification Specialty (Please check all that apply) American Board of Veterinary Practitioners (ABVP) Avian Practice Equine Practice Beef Cattle Practice Feline Practice Canine & Feline Practice Food Animal Practice Dairy Practice Swine Health Management American Board of Veterinary Toxicology (ABVT) American College of Laboratory Animal Medicine (ACLAM) American College of Poultry Veterinarians (ACPV) American College of Theriogenologists (ACT) American College of Veterinary Anesthesiologists (ACVA) American College of Veterinary Behaviorists (ACVB) American College of Veterinary Clinical Pharmacology (ACVCP) American College of Veterinary Dermatology (ACVD) American College of Veterinary Emergency & Critical Care (ACVECC) American College of Veterinary Internal Medicine (ACVIM) Specialty of Cardiology Specialty of Neurology Specialty of Oncology American College of Veterinary Microbiologists (ACVM) American College of Veterinary Nutrition (ACVN) American College of Veterinary Ophthalmologists (ACVO) American College of Veterinary Pathologists (ACVP) American College of Veterinary Preventive Medicine (ACVPM) American College of Veterinary Radiology (ACVR) American College of Veterinary Surgeons (ACVS) American College of Zoological Medicine (ACZM) American Veterinary Dental College (AVDC) Please consider volunteering for an MVMA Committee Continuing Education Legislative Public Health Disaster Medicine Membership Public Relations Human Animal Bond Professional Affairs Areas of Expertise (species specific) I hereby apply for membership in the Maryland Veterinary Medical Association. If accepted into membership, I certify that I will abide by the MVMA Constitution, Bylaws and Principles of Veterinary Medical Ethics. I understand my credit card will not be charged if my application is not accepted. MVMA estimates that six percent of your membership dues are not deductible because of MVMA's lobbying activities on behalf of its members. Your membership dues may be deductible as an ordinary and necessary business expense, but are not deductible as a charitable contribution. PAYMENT INFORMATION Please charge $ to my: VISA MasterCard American Express Card Number Exp. Date CSC # What's this? Cardholder name Billing Address City State Zip MVMA Privacy Notice l MVMA Security Policy l MVMA Return Policy © 2011 Maryland Veterinary Medical Association Maryland Veterinary Medical Association l 3230 Maiden Lane l Suite 5 l Manchester, MD 21102 l phone: 443-507-6500 l fax: 443-507-6519 e-mail: mvma@managementalliance.com
FIND AN MVMA VETERINARIAN
Doctor's Name Practice Name City State (use two character abbreviation such as MD) Zip Code
Practice Name
City
State (use two character abbreviation such as MD)
Zip Code
SEARCH THE MVMA WEB SITE
Enter your search terms
Please complete the following form and click the submit button to apply for membership in the Maryland Veterinary Medical Association. This application must be accompanied by the full membership dues for the first year.
To download a printable application to return by fax or U.S. Mail, click here.
Academic Membership Dues
$80/year
Academic membership shall consist of graduates of a College of Veterinary Medicine who are employed by academic veterinary medical institutions and who are not in private practice. Academic members may not vote or hold office, but otherwise shall have all the privileges of active members. Academic veterinarians wishing to have voting rights may instead select apply for regular membership.
First Name MI Last Name
Position/Title
Employer
Office Address
City State Zip
County Allegany County Anne Arundel County Baltimore City Baltimore County Calvert County Caroline County Carroll County Cecil County Charles County Dorchester County Frederick County Garrett County Harford County Howard County Kent County Montgomery County Prince George's County Queen Anne's County St. Mary's County Somerset County Talbot County Washington County Wicomico County Worcester County
Home Address
Which address do you wish to appear in the directory?
Home Office
Office Phone Home Phone
Fax Mobile Phone
Business E-mail
Personal E-mail
Undergraduate School Year
Degree
Veterinary School Year
Degree(s)
Date of Birth City State
Marital Status Single Married Spouse's Name
Board Certification Specialty
(Please check all that apply)
American Board of Veterinary Practitioners (ABVP)
Avian Practice
Beef Cattle Practice
Canine & Feline Practice
Dairy Practice
American Board of Veterinary Toxicology (ABVT)
American College of Laboratory Animal Medicine (ACLAM)
American College of Poultry Veterinarians (ACPV)
American College of Theriogenologists (ACT)
American College of Veterinary Anesthesiologists (ACVA)
American College of Veterinary Behaviorists (ACVB)
American College of Veterinary Clinical Pharmacology (ACVCP)
American College of Veterinary Dermatology (ACVD)
American College of Veterinary Emergency & Critical Care (ACVECC)
American College of Veterinary Internal Medicine (ACVIM)
Specialty of Cardiology
Specialty of Neurology
Specialty of Oncology
American College of Veterinary Microbiologists (ACVM)
American College of Veterinary Nutrition (ACVN)
American College of Veterinary Ophthalmologists (ACVO)
American College of Veterinary Pathologists (ACVP)
American College of Veterinary Preventive Medicine (ACVPM)
American College of Veterinary Radiology (ACVR)
American College of Veterinary Surgeons (ACVS)
American College of Zoological Medicine (ACZM)
American Veterinary Dental College (AVDC)
Please consider volunteering for an MVMA Committee
Continuing Education
Legislative
Public Health
Disaster Medicine
Membership
Public Relations
Human Animal Bond
Professional Affairs
Areas of Expertise (species specific)
I hereby apply for membership in the Maryland Veterinary Medical Association. If accepted into membership, I certify that I will abide by the MVMA Constitution, Bylaws and Principles of Veterinary Medical Ethics. I understand my credit card will not be charged if my application is not accepted.
MVMA estimates that six percent of your membership dues are not deductible because of MVMA's lobbying activities on behalf of its members. Your membership dues may be deductible as an ordinary and necessary business expense, but are not deductible as a charitable contribution.
PAYMENT INFORMATION
Please charge $ to my:
VISA MasterCard American Express
Card Number Exp. Date CSC # What's this?
Cardholder name
Billing Address
State Zip
MVMA Privacy Notice l MVMA Security Policy l MVMA Return Policy
© 2011 Maryland Veterinary Medical Association
Maryland Veterinary Medical Association l 3230 Maiden Lane l Suite 5 l Manchester, MD 21102 l phone: 443-507-6500 l fax: 443-507-6519
e-mail: mvma@managementalliance.com
