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2015/2016 OAVT Membership Renewal/Application
22012012014/20152014/2015
CONTACT INFORMATION
PLEASE CHECK BOX WHICH APPLIES
Last Name:
Address:
City:
Home Phone:
Email:

RENEWAL

NEW MEMBER
First Name:
Apt. #:
Postal Code:
Province:
Alt. Phone:
MEMBER NO.;
STUDENT INFORMATION (applicable to students and current graduates)
College of Graduation:
Year of Graduation:
Program Name:
Location:
HAVE YOU REGISTERED FOR
VTNE JUL/AUG WINDOW

YES
EMPLOYER INFORMATION:
Current Employer:
Address:
Province:
Start Date:
City:
Postal Code:
Wk. Phone:
By signing below, I hereby make application for membership to the Ontario Association of Veterinary Technicians and will conduct myself in
accordance with all By-laws, Policies, Code of Ethics, and Objectives of the Association (please refer to www.oavt.org for further details). I certify
that the above information is true and correct. I authorize the OAVT to verify the provided information. As a member of the Ontario Association of
Veterinary Technicians, you are consenting to receiving electronic communications from the OAVT, and occasional messages on behalf of 3rd party
organizations offering services that are of interest to OAVT members. Unsubscribe options are available at the bottom of these emails.
Date:
Applicant Signature:
Selected Membership Level
Annual Term
Yearly Rate
RVT
June 1 – May 31
$257.64
Individuals in the process of achieving
RVT status
PENDING
June 1 – May 31
$257.64
Currently enrolled in OAVT accredited
Veterinary Technician/Technology program
A person who has graduated from a course
of study not accredited by OAVT, or chosen
not to pursue Registered status
An RVT who is retiring from the profession
permanently, and age plus years of service
equals or is greater than 65
STUDENT
June 1 – May 31
$22.60
LIMITED
June 1 – May 31
$212.44
RETIRED
June 1 – May 31
$45.20
Renewal of RVT membership
Amount Paid
HST (131435703) included in total amount due; Late fee of $56.50 added to renewals received after Aug. 3, 2015
PAYMENT INFORMATION


 Cheque or Money Order
Verification Code:
Number:
(3 digits on back)
Card Number:
Exp. Date:
Name on Card:
Cardholder
Signature:
Dues Paid By
All payments made by credit card must
include a cardholder signature to be valid
 Member
 Employer
100 Stone Rd W. St. 104, Guelph, ON | N1G 5L3 | phone: 1-800-675-1859 | fax: 519-836-3638