2008-09 NMVMA Dues Statement

We are currently not accepting credit card information for Dues payments over the internet. Please fill this form out, print it and either fax or mail it. No information can be retrieved from this form over the internet.

Full Name

NMVMA Annual Membership Dues for 2008-2009 @ $150.00

Contribution to Scholarship Foundation (Optional)
To help sponsor N.M. Veterinary Students

2008 New Graduate (no fee first year)

2006-07 Graduate ($75)

Retired Members ($75) (Applicable only with prior Executive Board approval)

Honorary/Distinguished Lifetime Members (no fee)
(Applicable only with prior Executive Board approval)

Total Dues Remitted (This is not a self-calculating form - Please enter amount)

MC VISA AmExp

Credit Card # Expires

I hereby authorize the NMVMA to charge my account for this fee.

Name as it appears on the card

Fax or mail to:
Tamara Spooner
60 Placitas Trails Road
Placitas, NM 87043
Fax: 505.771.8963