2014 Membership Renewal Form
Renew and pay online today under "account" at easav@edmontonvetinfo.com
OR
Return a copy of this completed form with a $110.00 cheque made payable to
The Edmonton Association of Small Animal Veterinarians
Mailing Address: EASAV, P.O. Box 31029, Namao Centre, Edmonton, AB T5Z 3P3
Individual Veterinarian Membership for 2014 is $110.00
Renewal deadline is January 31, 2014.
Please include payment of membership(s) along with this portion of the registration form. (Required for each member)
DVM name: _____________________________ Clinic:_________________________
Email (required):_______________________________ Phone: _____________
Email addresses are used for EASAV communication and are kept strictly confidential.
A personal email address is required for each member.
Mailing Address, (If not with a clinic): _________________________________________________________________
_________________________________________________________________
CE Suggestions for 2015/2016:
______________________________________________________________________________
_________________________________________________________________
Are you willing to help the EASAV executive with projects during the year?
(Circle one): YES NO
Are you interested in volunteering for the Teddy Bear Hospital at Dreamnight at the Zoo: June 6, 2014: (circle one) YES NO
(If you would like more information about Dreamnight at the Zoo, please contact one
of your Executive Team Members or Smokey)
EASAV's locum list: is available online in the “member’s only” tab on the easav website. If you would like to be on it, please email your name, phone number and email address to Smokey at easav@edmontonvetinfo and put locum listing in the email subject. |