Please complete the following form to request membership in AABP

 

First Name:
Last Name:
Company/Office:
Address:
City:
State/Province
(ex, NY, WI)
:
Country:
Zip:
Phone:
Email:

Member Demographics:

In an effort to identify, recognize and celebrate the diversity of AABP members, please complete the following.

Gender:       Race:       Ethnicity:


Veterinary School:
If Other, name of veterinary school attended :
Grad Year:
By checking this box, I certify that I am a licensed veterinarian and have graduated from veterinary school.

District:
0 - International
1 - NH, RI, CT, NY, MA, VT, ME
2 - VA, PA, MD, DC, DR, NJ
3 - FL, GA, MS, SC, TN, NC, AL
4 - KY, MI, OH, WV
5 - IL, IN, WI
6 - MN, IA

7 - MO, OK, KS
8 - AR, LA, TX
9 - CO, ND, WY, NE, UT, NM, SD
10 - HI, AZ, CA, NV
11 - WA, MT, OR, AK, ID
12 - PE, QC, NS, NB, NL, ON
13 - SK, BC, AB, MB

Employer Type:
Academia
Government
Armed Forces
Farm/Ranch Owner
Farm/Ranch Staff Veterinarian
Private Practice Owner
Private Practice Employee
Retired
Industry
Other
Board Certifications:

Veterinary License:

AABP must submit the state/province license number of attendees to RACE after conferences and webinars. RACE only requires one state/ province license to be entered. If you are licensed in more than one jurisdiction, RACE will apply your CE to all jurisdictions in which you are licensed, therefore only submit ONE jurisdiction and license number.


If you decline, your CE attendance will not be submitted and may not be approved by RACE even if you have a certificate of attendance.

State/Province:    Number:

 

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