VETERINARY EMERGENCY & CRITICAL CARE SOCIETY 2018 MEMBERSHIP APPLICATION Membership term is for twelve consecu ve months. A renewal reminder will be sent 30 days prior to your anniversary date. ______________________________________________________________________________________________________________________________________ Email Address (REQUIRED - This will be your online VECCS Member Username) Date ________________________________________________________________________________________________________ First Name MI Last name Degree/Certiﬁ cation (DVM, VMD, RVT, LVT, etc) ________________________________________________________________________________________________________ Practice Name (If applicable) ________________________________________________________________________________________________________ Address ________________________________________________________________________________________________________ City State/Province Zip/Postal Code Country (________)_______________________________________________ (________)______________________________________ Daytime Phone Fax If you prefer not to display your personal informa on on the VECCS website, please check this box: BOARD CERTIFICATION: (check all boxes that apply) ACVECC ABVP ACVAA ACVIM ACVS ECVAA ECVECC AVECCT AVTAA AIMVT AVDT AVNT AVST AVBT AVZMT AEVNT OTHER ___________ _______________________________________________________________ MEMBERSHIP DUES: Each category has the option of receiving JVECC online access only or hard copy (hard copy membership option will also have access to online Journal). Please check the box that applies below: ONLINE ONLY U.S./CANADA INTERNATIONAL JOINT VECCS/EVECCS* Veterinarian $165 $165 $210 Intern/Resident $90 $90 $130 Technician $70 $70 $120 Manager/Admin $70 $70 $130 Student $50 $50 $100 HARDY COPY & ONLINE U.S./CANADA INTERNATIONAL JOINT VECCS/EVECCS* Veterinarian $195 $215 $220 Intern/Resident $120 $140 $145 Technician $100 $120 $135 Manager/Admin $100 $120 $145 Student $80 $100 $110 *includes EVECCS Membership dues VETERINARY EMERGENCY & CRITICAL CARE FOUNDATION: For more informa on about the Founda on, please log on to www.veccf.org. I would like to contribute the following amount: $10 $25 $50 $100 $250 $500 Other $__________________ BILLING INFORMATION: Check in U.S. funds drawn on U.S. banks Visa Mastercard Discover American Express Card #: ______________________________________________________________________________________________ Exp. Date: ____________ 3 or 4 Digit Security Code: __________ Name on Card:_______________________________________ Please make check payable to VECCS and mail with applica on to: VECCS • 6335 Camp Bullis Rd., Ste. 12 • San Antonio, Tx 78257 Email: firstname.lastname@example.org • Fax: 210-698-7138 • VECCS Informa on: 210-698-5575
Journal of Veterinary Emergency and Critical Care – Wiley
Published: Jan 1, 2018
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