Member Join
(*=required field)

Title: Spouse's Name:
*First Name: Business /Clinic /Hospital:
MI: * Business email:
*Last Name: Business Website:
       
Home Address 1: Business Address 1:
Home Address 2: Business Address 2:
Home City: Business City:
State: Zip: State:  Zip:
Home County: Business County:
Home Phone: Business Phone:
Cell Phone: Fax:
     

Please check preferred mailing Address:
Home       Business      
     
Licensure: School of Veterinary Medicine:List school of which you are a graduate and year of graduation
California #:
School:
Other States:
Year:

Professional Practice Type
Or Specialty College

You may select multiple options by holding down the CTRL key and clicking each choice

Association Committees

Would you be interested in serving the Association
by appointment to membership on a committee?
Yes     No

Member Classifications

Please select a membership type:
Do you want to receive the Membership email :

"I hereby agree, if elected to membership in the Southern California Veterinary Medical Association, to abide by the Bylaws and Principles of Veterinary Medical Ethics of the Association."

Payment Information
Please check CC Billing Address:
Home       Business      

My annual dues payment is enclosed in the form of:
       American Express       Visa       Discover       MasterCard  

Credit Card No.:  (numbers only, no spaces)
Exp. Date:      Security Code: 

AutoPay (I want you to automatically renew my membership each year) :

Referring Member Information:

Referring DVM Member:

Referring Member Telephone #:

Contributions to the Southern California Veterinary Medical Association are not tax deductible as charitable contributions for income tax purposes. However, they may be tax deductible as ordinary and necessary business expenses subject to restrictions imposed as a result of association lobbying activities.

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Application Date : 7/23/2008

   
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