Membership Application
New Renewal
First Name:
Middle Initial:
Last Name:
Street Address:
Apt/Ste:
City:
State:
Zip Code: -
Home Phone: () -
Work Phone: () -
E-mail:

If employed, please complete:
Employer:
Employer Street Address:
Employer City:
Employer State:
Employer Zip Code: -
Type of Business:

School of Graduation:
Graduation Date: /
NC Registration Number:

If Student
What school do you attend:
What is your expected graduation date: /

Are you a VTS: Yes No  

Type of Membership

$30.00 Active membership (open to only Veterinary Technicians currently registered in NC).
$25.00 Associate/Staff membership (non-voting, open to Veterinary Assistants, Kennel staff, Receptionist, Groomers, etc..)
$15.00 Student membership (non-voting, open to Students currently enrolled in an AVMA accredited VMT program).