Home Contact Us Foundation
Annual Meeting Member Login
If you are a new member, continue with this form.
If you are a current member, please sign onto the "Member Login". There, all of your information will be filled in. If you don't have your password, feel free to contact the
MVMA at 651-645-7533 or email

Minnesota Veterinary Medical Association
101 Bridgepoint Way, Suite 100
South St. Paul, MN 55075
(651) 645-7533   FAX (651) 645-7539
Gender: Male      Female
First Name:   MI:
Last Name:
Date of Birth:
Spouse's Name:
Business Address 1:
Business Address 2:
Business City:
State:   Zip:
Business County:
Business Main Phone: ()
Business Phone Direct: ()
Business Fax: ()
Business Email:
Clinic/Business Website:
Home Address 1:
Home Address 2:
Home City:
State:   Zip:
Home County:
Home Phone: ()
Cell Phone: ()
Home Email:
Home Fax: ()


Please check preferred mailing Address:
Home       Business

Please check preferred Phone:
Home       Business       Cell Phone

Please check preferred Email Address:
Home       Business

Please check preferred method of Contact:
Phone       Email
Association Committees
If granted membership I would be interested in the following committees in 2014-2015
You may select multiple committees by holding down the CTRL key and clicking each committee


Do you have experience as an Emergency Vet. Response volunteer?
Yes       No
If no, would you be interested in training?     Yes       No


I would prefer to receive the annual MVMA Dues invoice:
by mail email/online


I would prefer to receive/read the MVMA Newsletter:
In Print       Online


I may have an interest in the following MVMA activities
You may select multiple activities by holding down the CTRL key and clicking each activity



SPECIES CODES: Select only those that you can currently treat.
You may select multiple species by holding down the CTRL key and clicking each specie


SPECIAL SKILLS: Check a MAXIMUM of 3 special skills that you provide. (only 3 special skills can be stored in your data file).
You may select multiple skills by holding down the CTRL key and clicking each skill

Please list ALL Board Certifications:  


SERVICES: Select only those that you currently provide.
You may select multiple services by holding down the CTRL key and clicking each service


Do you offer discounts?
Yes       No
(if yes, check all that apply and describe)
Seniors/Retirees      Multiple Animal      Cases Based On Need Participate in payment program
Discount Description: 


Do you make house or farm calls?
Yes       No
(please list if only for certain circumstances)


My Practice is:
Small Animal Exclusive   Large Animal Exclusive  Mixed Animal
Equine         Small Animal Mobile Relief Veterinarian


The MVMA values your ideas on improving your association. Please suggest what you would like to see the MVMA offer as a benefit to you or your practice. Also, please include any comments on what are currently your most important benefits of membership.



Member Classifications
Please select a membership type:


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


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

Credit Card No.:       Exp. Date: Security Code:

cvc code


DVM Reference:
Telephone: ()


Contributions to the Minnesota 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. The Minnesota Veterinary Medical Association estimates that the nondeductible portion of your dues - the portion which is allocable to lobbying - is 19%.





Minnesota Veterinary Medical Association
Copyright © 2015