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| CVTA Membership Application |
| Name: ___________________________________ |
| Address: ____________________________________ ____________________________________ |
| Home Phone: ( ____ ) _______________________ |
| Work Phone: ( ____ ) _______________________ |
| Employed By: ____________________________________________ |
| V.T. Program Attended / Year Graduated: ________________________________ |
| Type of Membership: (please circle one) RENEWAL (Full) $10.00 Associate (Office Staff/Assistant) $5.00 Affiliate: Degreed Tech, not currently registered $7.50 New Vet Tech Graduate: $5.00 Dues are to be renewed every SEPTEMBER. A $5.00 late fee will be assessed after November 30th. |
| Please print this page, fill it out in full, and mail it along with your check to: CVTA Treasurer C/O Sandy Schleibaum 6660 Ashley Ct. Mason, OH 45040 |
| Make all checks payable to The CVTA. |