AAPHV Membership Form

All members must send in an application annually to remain active.

Application type	New Renewing

First name
Last name
Maiden name	if applicable

E-mail address	required All communication from AAPHV is electronic
Phone	Work Home Cell
Mailing address
City
State
Country	for international members
ZIP/Postal code

Present position title
Organization
Organization address
City
State
Country	for international members
ZIP/Postal code

Graduates
Graduation year
Veterinary school

Current students
School
Degree program
Anticipated graduation

Please list other degrees and awarding institutions
Degree	Year Institution
Degree	Year Institution

All information above will be included in a database searchable only by AAPHV members. However, please indicate below any information you would like to omit from the directory (name is always included).

Please omit

Membership type	Active or Associate ($32) Student, Honorary or Life (free) Membership categories are described on page 2 of the AAPHV Bylaws. Students are defined as persons enrolled in colleges or schools of veterinary medicine, or current veterinarians pursuing full-time study.
Are you a current member of the American Veterinary Medical Association?	Yes No