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OVMA Membership Application

This form is for NEW Active, Resident/Intern, New Graduate, Associate, and Sustaining Members ONLY. If you would like to become a Life Member, please use the Application for Life Membership form.You may also download a printable application to mail to the OVMA. Students, please use the Student Membership Form. If you would like to renew your OVMA Membership, please use our Secure Online Renewal Form.

Contact Information
Applicant Name*
Home Address Information
Address*
City*
State*
ZIP*
County*
Phone*
E-Mail
Organization Information (if applicable)
Organization
Address
City
State
ZIP
Phone
Fax
Web Site
E-Mail
Preferred Contact Methods*
Mailing Address
Phone
E-Mail

Professional Information
Veterinary School Attended*
Graduation Year*
Primary Area
of Practice
(if applicable)
Equine Mixed Animal/General Practice
Academic/Teaching Research/Laboratory Medicine
Government/Military  

Membership Information
Membership Type*
In order to be approved for Resident/Intern membership status, the following information must be provided.
Organization
Supervisor's Name
Supervisor Title
Supervisor Contact
Please make a selection.

Payment Information
Credit Card Information*

website security
Card Type*
 VISA MasterCard Discover (Sorry, we cannot accept American Express)
Name on Card*
 CVV*  
Card Number*
Exp. Date*

Note: Your credit card will NOT be charged until our staff has confirmed your information and charges.

Payments and dues paid to the OVMA are not deductible for federal tax purposes as charitable contributions. They may be deductible as any ordinary and necessary business expense, except that portion of dues payments related to representation on legislative issues. The OVMA estimates the portion attributable to legislative advocacy to be 20% in 2012.