Maryland Veterinary Medical Association

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For the Veterinary Profession

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 plus a $5 initiation fee.

To download a printable application to return by fax or U.S. Mail, click here.

Regular MVMA Membership Dues	First Year	Second Year	Thereafter
(Less than two years out of school)	$55	$75	$220
(Two or more years out of school)	$100	$220	$220
Retired Membership Dues	$100
Associate Membership Dues	$100

(Veterinarians who are residing and/or working in other states who agree to abide by the Principles of Veterinary Medical Ethics and Constitution and Bylaws)

First Name MI Last Name

Office Name

Office Address

City State Zip

County

Home Address

City State Zip

Which address do you wish to appear in the directory?

Home Office

Type of practice/activity

Office Phone Home Phone

Fax E-mail

Web site

Undergraduate School Year

Degree

Veterinary School Year

Degree(s)

Date of Birth City State

Marital Status Spouse's Name

Have you ever been a member of MVMA?

If yes, please give details.

Local Constituent Association to which you belong.

Office Held

Payment Information

I understand my credit card will be charged $ plus the $5 initiation fee for a total of

$ . Please charge my:

Card Number Exp. Date CSC No. (What's this?)

Name of Cardholder

Billing Address

City State Zip

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.

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Maryland Veterinary Medical Association l 8015 Corporate Drive l Suite A l Baltimore, MD 21236 l phone: 410-931-3332 l fax: 410-931-2060

e-mail: mvma@managementalliance.com