New Member Application...

Please fill in the below information and click on the submit button when completed:

Login/Account Information
UserName    *	This is your unique username used for login later.     If the username is already taken by another user, then you have to choose another.
Password     *	This is your password used for login later.     Password minimum length : 8 characters.  Non-alphanumeric characters required: 2.     ( Password Example:  Animals4Life2, Yht45xe91 etc  )
Email   *
* = Required field.
Personal Information
First Name
Middle Name
Last Name
Suffix
Spouse 's name (if applicable)
Address 1
Address 2
City
State
Zip Code
Phone
Degree	DVM VMD Other
School
Graduated
Speciality: ( More than one may be selected )	Companion Animal Food Animal Equine Mixed Government Industrial Faculty Exotic   Other
Practice Information
Practice Name
Address 1
Address 2
City
State
Zip Code
Phone
Fax
Membership Information
Please indicate Membership Type:        ( More than one may be selected)	Primary Veterinarian         $260.00      (**includes $10 voluntary legislative donation & $25 PAC contribution) Multi-Veterinarian Practice  For additional members at the practice with the same address. : $220.00      (**includes $10 voluntary legislative donation & $25 PAC contribution) Veterinary Faculty Member of VMRCVM   :  $197.00 Retired or Non-Resident Members     : $147.50      (**includes $10 voluntary legislative donation & $25 PAC contribution) Industrial; Government and Research Members     : $145.00 2011 graduate    : $125.00 2012 graduate    : $50.00 For Primary Veterinarian, Multi-Veterinarian, and Retired or Non-Resident Members ONLY:
Deduct from Membership fee:	$10 legislative donation $25 PAC contribution
Please indicate additional contributions:
Make an additional contribution to Veterinarian's PAC.
Make an additional contribution to Legislative Affairs.
May we share your contact information with your alma mater (check to approve)?
Check here if you DO NOT want the VVMA to email or fax you association information.
How would you like to receive our newsletter	Paper Copy Electronic Notification
How did you hear about us?
Who is the Credit Card issued to?	Hospital/Clinic Personal Credit Card

                                                                        



Notes:

1. Donations to Legislative Affairs are not PAC contributions.
2. PAC contributions are NOT TAX DEDUCTIBLE.
3. Dues payments to VVMA are not deductible as charitable contributions for Federal Income Tax purposes.
4. However, the portion of the dues not attributable to VVMA Legislative Affairs may be tax deductible as ordinary and necessary business expenses.
5. VVMA estimates that 14% of your 2012 dues are attributable to Legislative Affairs and are not tax deductible for Federal Income Tax purposes.
6. Voluntary donations for Legislative Affairs are not tax deductible for Federal Income Tax purposes. However, they maybe tax deductible as ordinary and necessary business expenses. Retain this portion of your statement for your 2012 tax filing. Consult your tax advisor.

If you have questions please contact the VVMA Office:
(T) 800-937-8862 (F) 804-346-2655 Email: vvma@aol.com