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Maryland

Veterinary

Medical

Association

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 

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    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

 

                        

 


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2013 Maryland Veterinary Medical Association

Maryland Veterinary Medical Association l PO Box 5407 l Annapolis, MD 21403
phone: 410-268-1311 l fax: 410-268-1322

e-mail: MVMA@KeyAssnMgt.com