Create a New Membership Account

STUDENT, LIFE AND ACTIVE DUTY MILITARY: Do not click the button to Continue to PayPal. We will manually review and activate your account. Mahalo! 

New Membership

Choose a Username*

Membership Type*

<---- Select One ---->Active MemberAffiliate MemberLife MemberMilitary MemberVeterinary StudentGraduated This Calendar YearGraduated Last Calendar YearRetired

Check if this is a new membership.

Title

<---- Select One ---->Dr.Mr.Mrs.Ms.

First Name*

Last Name*

Email*

Confirm Email*

Hide your email address from the member list? (List is only viewable to logged in HVMA members)

Primary Business or Employer's Name

Business Address

City

State

Zip Code

Business Phone

Country

Website

Are you an owner of this business?

Yes
No

Please describe your role in your primary business or place of employment:

Home Address (we won't share this information with anyone)*

City*

State*

Zip Code*

Home Phone*

Cell

What number do you prefer to be contacted at?*

<---- Select One ---->BusinessHomeCell

Preferred Mailing Address:*

Home
Business

Are you an active member of any other veterinary associations? If so please list them here along with any officer or board positions that you have held.

Please describe for us your work experience in veterinary medicine along with any advanced certifications or special skills that you have.

Feel free to share your hobbies or anything else interesting about your life outside veterinary medicine.

Need to build your resume? Are you interested in developing your leadership and networking skills by volunteering with the HVMA?*

Heck Yeah!
Not for Now

Do you have any special skills or talents that you would be willing to offer as a volunteer? (Examples might be writing or graphic design).

How will you be paying? *

Credit Card or PayPal
I'll Send a Check
Not Applicable

Name on Card or Checking Account (or say Same)*

Name of veterinary school you graduated from and year of graduation:*

In what state is your primary veterinary license?*

What is your license number?*

Please list any other states you have held a license in. Include the license number in that state and whether it is active or inactive.

Please list the names of two active members of the HVMA who are sponsoring your membership. If you don't know two active members please send an email to membership@hawaiivetmed.org and tell us a little about yourself. *

Yes! I want to receive occasional communications from my HVMA such as quarterly newsletters, legislative updates, and annual conference information.

I certify that the above information is true and correct to the best of my knowledge and agree to the Terms of Use and Privacy Policy. *

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