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Yes! Enroll me in the Veterinary
Health Care Team of Arizona as an:
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Active Member
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Non-AzVMA Active Member
r Associate
Member
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Student (If a student, please
provide name of college)____________________________________
I am a:
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Technician (CVT, LVT)
r Front
Office Staff r Veterinarian r
Assistant
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Kennel Staff
r Educator
r Manager r Allied
Representative
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Other
I work with:
r Small
Animals r
Large Animals r
Exotics
r Wildlife
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Zoo
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I am licensed: State___________________License
#____________________________________
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I am interested in serving as a committee/board volunteer.
Name:__________________________________________________________________________________________
Hospital/Clinic:___________________________________________________________________________________
Bus.
Address:____________________________________________________________________________________
City/State/Zip:____________________________________________________________________________________
Phone:
________________________________________
Fax:____________________________________________
E-mail:
_________________________________________________________________________________________
Home
Address___________________________________________________________________________________
City / State /
Zip:_________________________________
Home Phone:__________________________________
Where would you
like us to send your mail?
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Home r
Business