Member Join
(*=required field)

 
Title: Business /Clinic /Hospital:
*First Name:    
MI: * Business email:
*Last Name:    
Date of Birth:   Pick a date    
Spouse's 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: Business Fax:
     

Please check preferred mailing Address:
Home Address  Business Address 

Licensure: School of Veterinary Medicine: List school from which you graduated and year of graduation.
School: Year:
California Lic #: Other States:

Board Certified Specializations and/or Advanced Degrees

You may select multiple options

Anesthesia Avian Behavior
Cardiology Dentistry Dermatology
Emergency Medicine and Critical Care Equine Feline
Food Animal Internal Medicine Laboratory Animal
Neurology Nutrition Oncology
Ophthalmology Pathology Pharmacology
Practitioners Board Radiation Oncology Radiology
Reproductive Medicine Surgery Zoological Medicine

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
(Price reflects prorated cost of membership, dues are collected at the same time each year):
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:
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Credit Card No.:   (numbers only, no spaces)
Exp. Date:      Security Code: 

AutoPay (Please 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 : 9/6/2010

   
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