American Association of Small Ruminant Practitioners
 __________________________

 2008 New Membership Application

AASRP is a scientific, educational association under Section 501(c)(3) of the Internal Revenue Code.  Dues payments to AASRP may qualify as charitable contributions for Federal tax purposes.

Name: __________________________________________________________________________

Clinic/Business: __________________________________________________________________

Address: ________________________________________________________________________

City/State/Zip Code:_______________________________________________________________

Country:_________________________________________________________________________

Phone:__________________________________  Fax:___________________________________

E-mail: _________________________________________________________________________

Veterinary College: ______________________________________ Year Graduated:___________

Please check the category that best describes you:

Veterinarian: ____ Owner/Partner  ____ Associate  ____ Academician/Researcher  ____ Industry  ____ Government  _____    
 Other ______________________________________________

Non-Veterinarian: ___ Associate ___ Student

Would you accept externships?  _____ Yes     _____  No


Member of (check all that apply):  _____ AVMA         _____Canadian VMA         _____  USAHA

Percent of time spent with:     _____% Sheep          _____% Goats         _____% Llamas         _____% Deer/Elk

AASRP Membership Dues Payment*

DUES STRUCTURE:

  ______ Veterinarian
  ______ Non-Veterinarian Associate
(Retired members deduct 50%)
  ______ Veterinary Student
  ______ Contribution to Samuel B. 
               Guss Memorial Fund

TOTAL ENCLOSED

 US/Can
 $75
$75

$15

 


 Foreign
 $100
$100

$20

 

US
Funds
$______
$______

$______
$______

$______

  PAYMENT METHOD:  ____ Visa  ____ MasterCard ___ Check
     (payable to AASRP and drawn on US bank in US funds)

  Card #:  _________________________________________ 

  Exp Date: ________________________________________

  Signature: _______________________________________

     *Please mail  this form with payment to  AASRP, P.O. Box 611, Guthrie, KY  42234 or fax (270) 483-9833.  Please contact the AASRP office at (270) 483-2090 with any questions.
   * *A tax deductible contribution to the Samuel B. Guss Memorial Fund helps provide small grants to student members of  
     AASRP to undertake extern opportunities in veterinary practices, working with one or more of the small ruminant species.