NYCAVMA Membership Enrollment Form
Dues are $65.00 annually, and membership is for a term of one year.
Member Name
*
First Name
Last Name
Practice Name
If applicable.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Website
If applicable.
Modalties you're certified in - check all that apply.
Acupuncture
Chiropractic
Herbal Medicine: Chinese
Herbal Medicine: Western
Osteopathy
Reiki
Homeopathy
Homotoxicology
Shamanistic Healing
Nutritional
Other
Modalities -Certifications/Degrees
Species Treated
Dogs
Cats
Horses
Farm Animals (Cows, Goats, Llamas, Sheep, Pigs)
Birds/Poultry
Small Animals (Hamsters, Rabbits, Ferrets)
Reptiles
Other
Years of experience
*
Office Hours
If applicable.
Other Info
(Information about your practice/specialties you'd like displayed on the website.)
JOIN THE NYCAVMA
prev
next
( X )
NYCAVMA Membership
$
65.00
Annual Dues for Membership in the NYCAVMA.
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card
SUBMIT
Should be Empty: