Wyoming Veterinary Technician Association

PO Box 34
Cody, WY 82414

(719)464-7466

www.wyvta.org

Application for Biennial Membership: 2021-2022

 

Approved membership will be effective January 1, 2021 – December 31, 2022

 

(Membership Year is EVEN. Expiration date ends in an odd year)
Check your Membership Number on your Member Card “WVTA XX-YYYY” where XX is your Member Year

 

CVT, VA, Associate membership = $40/biennial
(CVT, hospital staff, veterinarian, public)

VT Student = $30/biennial     (individual membership)

CLICK HERE TO DOWNLOAD APPLICATION for 2021-2022

OR SUBMIT THE ONLINE FORM BELOW

Application Form

Name
First Name
Last Name
Mailing Address
Street Address
City
,		State / Province
Zip / Postal Code
Work Name

Work Address
Street Address
City
,		State / Province
Zip / Postal Code
Work Phone

E-Mail Address :
School Name (please write out full name

Graduation Date :
RVT, CVT, LVT number

Issuing state

Please check the appropriate selection

Credentialed Veterinary Technician
Veterinary Assistant
Graduate Veterinary Technician


Associate Member (select the type)

DVM
Other
Staff
Industry/Research


What type of hospital/institution do you work for?

Please list which committee(s) you would like to serve on?

Nominations
Membership
Continual Education
Newsletter
NAVTA


Other interests

As a member of the Wyoming Veterinary Technician Association, I will abide by the Constitution, Bylaws, and Rules of the Association.

Yes
No


DUES MUST ACCOMPANY APPLICATIONS; please make checks payable to: WyVTA
Send completed applications and dues to: Jackie Van Noy, CVT; WyVTA Membership & Certification 1532 26th St Cody, WY 82414
Enter the last 4 digits of the credit card you'll be using. Or if sending a check, type in CK

-- ASSOCIATION USE ONLY-- (nothing for you to fill out)
Date Received: . Check #: . Amount: . Membership card sent: . CE received: . Are things correct?: . Follow up: _______ / ________ / _________

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