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Maryland

Veterinary

Medical

Association

MVMA RVT 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.

Registered Veterinary Technician Membership Dues

$25/year

The Registered Veterinary Technician membership shall consist of Registered Veterinary Technicians (RVT) who have been recommended by a regular member of MVMA. Registered Veterinary Technician members may not vote or hold office.

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  

Veterinary Technician School   Year    

Degree 

Date of Birth    City    State

Marital Status    Spouse's Name 

RVT Sponsor

MVMA Member's Name      

Practice Name      

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 12 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