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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 info@mvma.org


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:
Suffix:
Date of Birth:
Spouse's Name:
Business/Clinic/Hospital:
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 2013-2014
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

 

IMPORTANT!! PLEASE COMPLETE THE FOLLOWING SURVEY CAREFULLY. IT WILL UPDATE OUR DATABASE WITH ACCURATE AND CURRENT INFORMATION TO BE USED FOR PUBLIC REFERRALS.

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)

 

Do you have expertise in any particular dog breed(s)?
Yes       No
(If yes, which breeds?)

 

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 © 2014