Veterinary Defence Association, Australia
Full Name
*
Email
*
Work Phone
Home Phone
Mobile
*
Fax
Physical Address
*
Mailing Address differs from Physical Address
Yes
No
Mailing Address
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Veterinary School
*
Qualifications
*
Year of Qualification
*
Please Select
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
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1930
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1926
State Veterinary Medical Board
*
State Veterinary Medical Board License Number
Practise Name/Place where relief service provided
*
Company Name (If Applicable)
Small Animal %
Large Animal %
Equine %
Avian %
Exotics %
Other (please specify) %
Other
Total (needs to add up to 100)
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Claims / Complaints
Yes
No
Prior Claims Date
Prior Claims Details
Outcome
Names of other Veterinarians in Your Practice
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Calculation
Bla
Bla2
Payment Method
Please Select
Paypal
EFT
Membership Options
Please Select
Low VDA membership
Medium VDA membership
High VDA membership
Paypal
Banking Details - You will receive a communication with the banking details when submitting this form
Full Membership ($540)
Part Time ($440)
Lincoln Advantage ($440)
Nurse Membership ($270)
Student Vets ($25)
NB. New membership fees are charged pro-rata when joining outside the month of June
Total
Membership Options
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Membership Options
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