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American Veterinary Medical Law Association - Membership 2 (Page 1)

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American Veterinary Medical Law Association - Membership 2
Please print this application form and mail it with your check to
the AVMLA at the address listed below. Thank you!
THE AMERICAN VETERNARY MEDICAL LAW ASSOCIATION
Membership Application
(as of 01-JAN-2004)
Full name
Spouse's full name
Home address
Business address
Home phone
Business phone
Fax
Home e-mail
Business e-mail
List all professional degrees with school and year
List all states in which licensed
DVM
JD
Other
Past professional experience (Veterinary and/or Legal)
Current professional activity

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