Veterinary Defence Association, Australia
Full Name
*
Email
*
Work Phone
Home Phone
*
Mobile
Fax
Physical Address
*
Mailing Address differs from Physical Address
Yes
No
Mailing Address
Back
Next
Veterinary School
*
Qualifications
*
Year of Qualification
*
Please Select
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
State Veterinary Medical Board
*
State Veterinary Medical Board License Number
Practise Name/Place where relief service provided
*
Company Name (If Applicable)
Small Animal %
Large Animal %
Equine %
Avian %
Exotics %
Other (please specify) %
Other
Total (needs to add up to 100)
Back
Next
Claims / Complaints
Yes
No
Prior Claims Date
Prior Claims Details
Outcome
Names of other Veterinarians in Your Practice
Date
-
Month
-
Day
Year
Date
Calculation
Bla
Bla2
Payment Method
Please Select
Paypal
EFT
Membership Options
Please Select
Low VDA membership
Medium VDA membership
High VDA membership
Paypal
Banking Details - You will receive a communication with the banking details when submitting this form
Full Membership ($520)
Lincoln Advantage ($420)
NB. New membership fees are charged pro-rata when joining outside the month of June
Total
Membership Options
prev
next
( X )
USD
Membership Options
Pay with PayPal
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
Should be Empty: