Academy of Veterinary Allergy& Clinical Immunology Membership Information



ACTIVE MEMBERSHIP shall be limited to those veterinarians who devote a significant portion of their professional activities to research, teaching, or practice of Veterinary Allergy and Immunology, and whom the Executive Board of the Academy of Veterinary Allergy & Clinical Immunology consider eligible as active members because of their contribution or training in allergy and/or immunology.

ASSOCIATE MEMBERSHIP (Veterinarians) shall be open to all veterinarians who are interested in Veterinary Allergy and Immunology but do not qualify for active membership. Associate members shall not have the right to vote or hold office in the organization.

AFFILIATE MEMBERSHIP shall be open to non-veterinarians interested in Veterinary Allergy and Immunology.

1. All applications must be received by the membership and credentials committee at least 60 days prior to the annual meeting of the AVACI.
No exceptions will be made.

2. Please ask (2) members of the AVACI to submit a letter of recommendation to the membership and credentials committee at least 60 days prior to the annual meeting of the AVACI. Recommendation letters are not required for Associate or Affiliate membership.



I hereby make application for membership in the Academy of Veterinary Allergy as an: (check one)

O ACTIVE MEMBER
O ASSOCIATE MEMBER (VETERINARIAN)
O AFFILIATE MEMBER (NON-VETERINARIAN)

Name and Title:__________________________________________________________________________

List Business and Residence

Address ____________________________________________________________________________

City ______________________________________________________________________________

State Zip___________________________________________________________________________

Telephone__________________________________________________________________________

Fax ______________________________________________________________________________

Please send correspondence to:(check one)

0 Business or
0 Residence

If applying for ACTIVE membership, please supply the names of your sponsors:

    ______________________________________________________

    ______________________________________________________

EDUCATION

Institution, Degree Earned, Date

______________________, __________________________, ____________________

______________________, __________________________, ____________________

______________________, __________________________, ____________________

______________________, __________________________, ____________________


Institutional Affiliations:___________________________________________________

_______________________________________________________________________

_______________________________________________________________________

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List Present activities involving allergy and immunology (research, teaching, practice, etc.)
_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

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Percentage of professional activity devoted to veterinary allergy and immunology-: _____%

List all allergy and immunology training, short courses, seminars, publications, research
projects, etc. with dates and instructors. Two sheets may be attached. Please do not
enclose an entire curriculum vitae.
________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

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Signature:____________________________________Date:________________________




Interested veterinarians who qualify are encouraged to print the application page,
and mail the completed form to the Academy for membership application.

Return to:

Frederick Feibel, D.V.M.
Membership Chairman, AVACI
328 West Main Street
Avon, CT 06001

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