<div align="right"> <blockquote> <blockquote> <blockquote> <p><em><span style="font-size: 12pt; font-family: 'Times New Roman'"><font face="Verdana" size="6"> <p><span style="font-size: 12pt; font-family: 'Times New Roman'"><font face="Verdana" size="6">Seattle-King County Veterinary Medical Association</font></span></p></font></span></em></p></blockquote></blockquote></blockquote></div>

website maintained by
SKCVMA-PIC
(Public Information Committee)

You can use this online form for 2012 SKCVMA membership.  After the form is filled in and submitted, you will be taken to a page where you can pay dues using a credit card via PayPal.  Please note, you must fill in the form once for every separate member you wish to pay membership for, as well as make separate PayPal payments for each member.

 

If you do not chose the online payment option, we will contact you regarding how you do wish to pay dues.

 

Otherwise, please download the SKCVMA 2012 Membership form (pdf) and mail it along with your SKCVMA Membership dues check to the address at the bottom of the form.

 

Attention Technicians: Please download the pdf Membership form and mail your check to SKCVMA for Technician Chapter Membership.

 

 


 

Form - Membership Info Form

Name (required)
First Name (required)
Last Name (required)
Work Address
Street Address
City
State/Province
Zip/Postal Code
,
Practice Name, Relief, or Retired (required)

Phone Numbers
Work Phone

Fax

E-Mail Address (required) :
Please indicate how you want to receive the monthly publication, Vet-Rap
Preferred address for Vet Rap; if not email, please give it in the next address area (required)
email
work
home

Mailing Address for VET-RAP (if you do not fill this out, email is your assumed delivery mode)
Street Address
City
State/Province
Zip/Postal Code
,
Would you like to be included on an email reminder list for upcoming SCKVMA CE and events?
(If you do not check a box, you will be included on this list)
yes
no

Would you like to volunteer for any of these committees?
Continuing Ed
Professional mediation
Disaster Preparedness
Membership
Community Service
Public Information
Animal Cruelty Education
Chapter Chair
Your name and contact information will be publically listed on our website for any of the following:
Medically proficient at foreign language (specify below)
Make housecalls (indicate area below)
Practice complementary medicine
Practice on exotics (please list below)
Please type any details for above question here

Are you a clinic owner or medical director? (if yes, your hospital will be listed on our website) (required)
yes
no

The verification code below ensures the form is not submitted by a computer
Verification Code :
Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.