AASRP Online Membership Application Form

Use this form only if paying by credit card for new member dues or renewals. If you wish to pay by check or money order, click here (to download the appropriate file).

Active membership is open to veterinarians or non-veterinarian members classified as Associate.
U.S. and Canadian membership fees are $75.00; International membership fee is $100.00.                         (Retired members receive 50% discount)
Student membership fees are $15.00; International students $20.00. 

Please provide the following contact information:
Name
Clinic/Business Name
Address
City
State
Zip
Country
Phone
Fax
E-mail
Veterinary College
Year Graduated
Please check the category that best describes you (please check one):
Owner/Partner Associate Academician/Researcher
Industry Government Other
Would you accept externships?   
Member of (check all that apply):
AVMA Canadian VMA USAHA
Percent of time spent with:
Sheep Goats Llamas
Deer/Elk
Type of Membership: (Membership is for a period of one year.)
    
Samuel B. Guss Memorial Fund:
Contribution to the Samuel B. Guss Memorial Fund: No Yes Total Donation:
Payment:
Credit Card:                    Card Number:
Name on Card:
Expiration Date: