Congress Advisory Committee Application Form
Committee name
Full Name
*
Title
Full name
Email
*
example@example.com
Phone number
Address
Full Signature and titles
Are you a licensed vet?
Yes
No
If not, what is your job title?
Nurse
Technician
Researcher
Student
What university/college did you graduate from?
Please choose your WSAVA Member Association
*
Please Select
Association of Companion Animal Practitioners Sri Lanka
Beijing Small Animal Veterinary Association
Federation of Small Animal Practitioners Association, India
Hong Kong Veterinary Association
Indonesian Small Animal Practitioner Veterinary Association
International Society of Veterinary Ophthalmology
Japan Small Animal Veterinary Association
Korean Animal Hospital Association
Malaysian Small Animal Veterinary Association
Mongolian Small Animal Veterinary Association
Pakistan Pets Veterinary NOiences Promotion Foundation
Philippine Animal Hospital Association
Shanghai Small Animal Veterinary Association
Singapore Veterinary Association
Taipei Veterinary Medical Assosiation
The Veterinary Practitioner Association of Thailand
Veterinary practioners association of Nepal
Vietnam Small Animal Veterinary Association
Current employment
please list all paid positions that you hold for any organisation, company or other
Volunteer position
please list all volunteer positions that you hold, such as board positions, committee positions for any organisation,company or other
Any other qualifications?
Do you believe there is any conflict of interest in relation to your employment&/or other positions and the WSAVA position for which you are applying?
Curriculum Vitae
*
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Please attach your CV in English
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Letter of support from your WSAVA Member Association
*
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Letter of Intent
*
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Letter of Intent addressing the duties outlined in the job description
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Please review the WSAVA Conflict of Interest Policy
available by following
this link
Please describe below any relationships, positions, or circumstances in which you are involved that you believe could contribute to a Conflict of Interest, whether actual, potential, or could be perceived.
Are you employed by, a director for, or a member of an advisory board or special interest group, for any WSAVA Industry Partner (sponsor).
Are you assisting in the design of clinical studies concerning the use of products manufactured by a WSAVA Industry Partner (sponsor)?
Do you hold investments in an organisation that is a WSAVA Industry Partner (sponsor)?
By select yes below, I hereby certify that the information given above is true and complete to the best of my knowledge, and that I have read and agree to abide by the WSAVA Conflict of Interest Policy. You can view the conflict of interest policy in the WSAVA Policy and Process Manual: https://wsava.org/wp-content/uploads/2025/02/Conflict-of-Interest-Policy.pdf
Yes
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