Surname First Name(s) What name would you prefer when we make contact with you MRCVS No. (if applicable) Address Contact Tele Nos
Email address (must be valid to verify application)
Practice Name (if applicable)
Practise Address
Breif description of present employment & experience in veterinary public health
Application of VPHA as a: Full member - £40.00 p.a. Full Member Retired - £20.00 p.a. Associate Member - £40.00 p.a. Student Member - £10.00 p.a. All applications must be supported by a proposer and a seconder both of whome are full members of VPHA. Election of members will takeplace at the next Council meeting. You must provide a name and email address for your proposer and seconder which is used to validate your application. Proposer details Seconder details If elected to membership by VPHA Council by submitting this application you agree to abide by the constitution of the Association and to pay the annual subscription fee by: Direct Debit Cheque Subscriptions are due on the 1st January.
