HCVMA Annual Dues Form

Annual Dues Form

2026
Annual dues are $125 per person if paid before March 1st and $150 per person after. Please note that we cannot do prorated dues.

Please make payment to HCVMA and mail to:

HCVMA

PO Box 1542

Hixson, TN 37343

OR

Fill out the form below and submit payment online. You should receive a confirmation email with your completed form and payment amount once submitted. If you do not and need a receipt, please let us know.

Email hcvmavets@gmail.com with any questions or to receive a paper form to mail in. Thank you!!
Number of Veterinarians:
Payment Enclosed ($):
$125 per person before March 1st, $150 per person after
Practice Name:
Name of Hospital
Practice Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Practice Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Practice Website:
Main Clinic Email:
example@example.com
Email Address to Send Completed Form/Receipt
example@example.com
Practice Name:

Name of Hospital

Street Address

City and StateTelephone Number

Zip Code
Email to send completed form/receipt for YOUR records:
Lead Vet, Practice Manager, etc.
4. Please fill out the following for the HCVMA roster, HCVMA email list and rabies clinics:
Please fill out the following for the HCVMA roster, HCVMA email list, and website. Email addresses are not shared on the website.
Veterinarian 1:

Name of VeterinarianEmail Address (for meeting notifications, etc)
Veterinarian 2:

Name of VeterinarianEmail Address
Veterinarian 3:

Name of VeterinarianEmail Address
Veterinarian 4:

Name of VeterinarianEmail Address
Veterinarian 5:

Name of VeterinarianEmail Address
Veterinarian 6:

Name of VeterinarianEmail Address
Any other Veterinarians? Please list name and email address and separate by line
Name/Email address

Checkout

Annual Dues

Please make sure to put the correct quantity of dues in the box so the total payment is correct as it is $125 PER PERSON (or $150 after March 1st), not per clinic. Thank you!

$150.00 Total Number of Veterinarians
Item subtotal:

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Annual Dues Form

Please fill out the following for the HCVMA roster, HCVMA email list, and website. Email addresses are not shared on the website.

Checkout*

Checkout