List areas of professional interest or expertise
Veterinary
Legal
I would be interested in serving the avmla in the following areas
(circle all appropriate)
Administration
Membership
Programs
Newsletter
Liaison with Professional Associations
Public Relations
Speakers Bureau
Other (specify)
Active Member - $
100.00* per year [Licensed veterinarian and/or licensed attorney, residing in a
recognized district of the AVMLA (U.S. or Canada). All rights and privileges.]
Associate Member - $
100.00* per year [Individual or organization with an interest in veterinary
medical law, not otherwise qualified for membership. Associate members enjoy all rights and privi-
leges except the right to vote and to hold office.]
Student Member - $40.00 per year [Student member is enrolled in either an accredited veterinary
school or law school. Student members enjoy all rights and privileges except the right to vote and to
hold office.]
MEMBERSHIP (Check appropriate item)
MAKE CHECKS PAYABLE TO AVMLA AND MAIL TO
AVMLA Membership, c/o Karen M. Wernette, D.V.M, 511 N. Country Ridge Court,Lake Zurich, IL 60047
(847) 540-0786
E-mail info@avmla.org
Web http://www.avmla.org
A printed directory of AVMLA members is planned for the near future and will be distributed to all members. An
electronic version of the directory may be created in the future and would be distributed to members only, via e-mail, a
members-only section of the AVMLA web site, and/or on a CD ROM or floppy disk.
PLEASE READ AND SIGN BELOW
I
would like to be listed in the AVMLA Directory:
Printed Yes No Electronic Yes No
I would like my home address, phone, email to be listed in the AVMLA Directory:
Printed Yes No Electronic Yes No
Please place a no next to any other information included in this form that you would not want listed in an AVMLA
directory, either printed or electronic.
SIGNED
DATE
* as of 01-JAN-2004
