AAWV Membership Application

Memberships are by calendar year. This membership is for:
2012 (current year: $50) 2013 (for the upcoming calendar year; $50)

Renewal This application is for the renewal of an existing membership.

New This application is for a new membership.

I am interested in free-ranging wildlife health issues, support the objectives of AAWV and would like to become a member in the following category:

Veterinarian (Active) - $50.00/year Veterinary Student - $20.00/year Subscribing - $50.00/year

Mailing Information:

Name:
Address 1:
Address 2:
City:
State/ Province:	Zip/Postal Code:
Country:
Home Phone:	Work Phone:
Fax:
email:

Current Institution/Affiliation/Position:

Veterinary school, year of graduation: AAWV Member Since?:

Are you an AVMA member? Yes No / AAZV member? Yes No

Wildlife Society member? Yes No / Wildlife Disease Association member? Yes No