Application Form - Central Indiana Veterinary Medical Association

Central Indiana Veterinary Medical Association Membership Application

Please complete ALL Requested information. You may complete this form online and pay for your dues at time of completion. Major Credit cards are accepted ( Mastercard, Visa, American Express and Discover). If you would prefer to mail in the form- please make your check payable to CIVMA.

Email Address ^*

First Name ^*

Last Name ^*

Address Details ^*

City ^*

State ^*

Country

Postal Code ^*

Company

License Number

License number for CE purposes

School

End Year

Profile Visibility ^*

Opt In for Text ^*

YES

Permission for CIVMA to send me TEXT messages

Phone

Membership Plan

Membership Plans

I accept Central Indiana Veterinary Medical Association terms of use, terms of use and privacy policy.

Central Indiana Veterinary Medical Association

Once this form and payment has been processed you will be a member of the CIVMA and be able to attend most CE meetings ( including meals) at no additional charge.

Membership Terms

Membership runs on an annual basis- January- December.

Annual Dues:

$100.00 for Veterinarians- includes CE credit

$40.00 for Veterinary Technician/Nurse includes CE credit,

$40.00 for Hospital Support

$100 for Associate/Industry Supporter

Recent Graduate Membership:

$0 for Veterinarians and Veterinary Nurse/Technicians Recent Graduates ONLY, membership is for the remainder of calendar year after graduation.

Mail to: CIVMA P.O. Box 36087 Indianapolis, IN 46236-0087

Questions: Please email civma.indy@gmail.com