AVMA Alternate Delegate FVMA

Nominations for AVMA Alternate Delegate

Name(Required)

First Last

FVMA Membership Number(Required)

Number

AVMA Membership Number(Required)

Number

Phone(Required)

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Resume and/or Curriculum Vitae

Please upload a copy of your latest resume and/or curriculum vitae.

Max. file size: 10 MB.

Are you a member of your local VMA?(Required)

Yes

Please provide the name of the local chapter and the name of a contact person

Acknowledgment(Required)

I understand that this position requires me to attend two (2) AVMA meeting per calendar year and four (4) FVMA meetings per calendar year.