Kentucky Veterinary Technician Association

2010 Membership Form

Name: _________________________________        License #: ____________________
Address: _______________________________        Home phone: _________________
City: __________________, State: __________        Cell phone:    __________________
Zip code: ______________
E-mail: _________________________________________________________________
Employer: ______________________________        Work phone: __________________
Address: _______________________________        Fax:__________________
City: __________________, State: __________
Zip code: ______________



Annual dues: (January 1 through December 31) Please check one.
•        _______ Full member (Licensed Technicians/Technologists)              $30.00/year

•        _______ Associate Member (Non-licensed, assistants, etc.)                $20.00/year

•        _______ Student (Please include name of school and                          Free
contact person)
School: ____________________________
Contact: ___________________________

Please make checks payable to KVTA (Kentucky Veterinary Technician Association)

Please mail forms and checks to:
     Felecia Jones, M.S., LVT
      Treasurer
     C/O Animal Health Technology
     Murray State University
     115 A., 100 AHT Center
     Murray, KY 42071
     270-809-7007
Membership