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New WAVMA Membership Application

To become a WAVMA member, please complete the information below. Make sure your primary e-mail is correct as you will receive an e-mail confirmation with your unique User Name and Password, necessary for access to your Profile and WAVMA Member-only Programs.

WAVMA Membership type applied for

Membership type applied for

Contact Details

* First name

Other Names

* Last name

* Preferred email

Secondary email

Telephone

Tel.(alternative)

Fax

Mobile/Cell

Web site url:

Address

Organisation

Position

Dept

* Address 1

Address 2

Address 3

* City/Town

* State/Province/County

* Post/Zip code

Country

Education

Vet Degree

Other degree (if not in list)

Graduation year:

University:

University City:

University Country:

If you experience any problems with you application, or logging into your membership profile, please contact the membership administrators.

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Secretariat

Christopher I. Walster BVMS MVPH MRCVS
WAVMA Secretary
132 Lichfield Road
Stafford, Staffordshire ST17 4LE
United Kingdom