CVTA Membership Application

Name: __________________________________________________________

Address: _________________________________________________________

______________________________________________________________

Home Phone: (__________)___________________________________________

Work Phone:  (__________)___________________________________________

Mobile Phone:  (__________)__________________________________________

Email Address for Newsletter Delivery: _______________________________________

V.T. Program Attended/Year Graduated: ______________________________________

Employed By: ______________________________________________________

If you would like to add the email of your clinic/workplace, please list below:

______________________________________________________________

Type of Membership – Please circle option below:

Renewal (Full) $15.00

New Vet Tech Graduate $10.00

Associate (Degreed Tech, Unregistered; Office/Staff Asst.) $10.00

Late Fee $5.00

Dues are to be renewed every SEPTEMBER. A $5.00 late fee will be assessed after November 30th.

Please mail this page, filled out in full, and mail it along with your check to:

CVTA Treasurer ℅ Alisa Martinez
4439 Ashland Avenue
Cincinnati, OH 45212

Make all checks payable to: CVTA

PDF Application