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(s) below:
Full Membership (Registered/Certified Veterinary Technician in the State of Ohio) $15.00
New Vet Tech Graduate (Full membership at a discounted rate) $10.00
Affiliate Membership (Degreed/Registered Veterinary Technician that is in a State other than Ohio) $15.00
Associate Membership (Unregistered Veterinary Technician or Hospital office Staff) $10.00
Late Fee (Dues paid after November 30th of the current Membership year) $5.00
Dues are to be renewed every SEPTEMBER. A $5.00 late fee will be assessed after November 30th.
Make all checks payable to: CVTA
Mail to: CVTA Treasurer c/o Ashley Berry 9536 West Ave., Blue Ash, Ohio 45242