Last Name:

First Name:

Middle Name:

Address:

City:

State:

ZIP:

Home Phone:

Business Phone:

email:

Fax:

States where licensed:

Specialty board certification:

Veterinary College:

Degree:

Year:

Other Degrees:

AVMA Membership: AVMA non-AVMA

Other Veterinary or Human-Animal Bond Associations:

Other Comments or Suggestions:

I hereby apply for active membership in the American Association of Human Animal Bond Veterinarians and will send membership dues for the current calendar year.

Membership Dues
Member Veterinarian $35.00
Associate Member (non-veterinarian) $25.00
Student Member $5.00

Remit Checks To:
AAHABV
Dr. Thomas Krall
St. Petersburg College
PO Box 13489
St. Petersburg, FL 33733