HCVMA Annual Dues Form

Annual Dues Form

2025
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.
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.

We no longer do Rabies clinics so no need to specify if you are willing to work one of those.
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 DuesPlease 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

Total

$0.00

Credit Card Details:
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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.