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Kentucky Veterinary Technician Association
2009 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
Vice-President/Treasurer
C/O Animal Health Technology
Murray State University
115 A., 100 AHT Center
Murray, KY 42071
270-809-7007
2009 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
Vice-President/Treasurer
C/O Animal Health Technology
Murray State University
115 A., 100 AHT Center
Murray, KY 42071
270-809-7007
Kentucky Veterinary Technicians Association
