SVSTS Membership Registration Form
Thank you for joining the SVSTS! We are excited to have you on board.
Please fill out this form, then membership dues can be paid here:
https://www.svstsurgery.com/Dues-Registration
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Title (Dr. Mrs. Mr. Etc.) *
First Name *
Last Name *
Organization Name *
Where do you work?
E-mail Address *
Note: This e-mail address will be the one added to the SVSTS List Serv
Street Address *
City *
State
Zip Code
Country *
Office Phone Number
Diplomate Status *
Special Interests
State of License *
State License Number (Required for CE Certificates) From new AAVSB guidelines: "By supplying your license number and state of licensure, you agree to sharing that information with the American Association of Veterinary State Boards (AAVSB) for the sole purpose of the RACEtrackยฎ powered by CE Broker continuing education tracking program. No other personally identifiable information will be shared with the AAVSB nor any of its vendors. RACEtrack allows you to record all your continuing education course work in a centralized database providing a simple way for you to exchange that information with your credentialing agencies. RACEtrack is a free service to all licensees. ๐—ง๐—ต๐—ฒ ๐—ฎ๐˜๐˜๐—ฒ๐—ป๐—ฑ๐—ฒ๐—ฒ ๐—ผ๐—ป๐—น๐˜† ๐—ป๐—ฒ๐—ฒ๐—ฑ๐˜€ ๐˜๐—ผ ๐—ฝ๐—ฟ๐—ผ๐˜ƒ๐—ถ๐—ฑ๐—ฒ ๐—ผ๐—ป๐—ฒ ๐—น๐—ถ๐—ฐ๐—ฒ๐—ป๐˜€๐—ฒ ๐—ป๐˜‚๐—บ๐—ฏ๐—ฒ๐—ฟ ๐˜๐—ผ ๐˜๐—ฟ๐—ฎ๐—ฐ๐—ธ ๐˜๐—ต๐—ฒ๐—ถ๐—ฟ ๐—–๐—˜, ๐—ฒ๐˜ƒ๐—ฒ๐—ป ๐—ถ๐—ณ ๐˜๐—ต๐—ฒ๐˜† ๐—ฎ๐—ฟ๐—ฒ ๐—น๐—ถ๐—ฐ๐—ฒ๐—ป๐˜€๐—ฒ๐—ฑ ๐—ถ๐—ป ๐—บ๐˜‚๐—น๐˜๐—ถ๐—ฝ๐—น๐—ฒ ๐—ท๐˜‚๐—ฟ๐—ถ๐˜€๐—ฑ๐—ถ๐—ฐ๐˜๐—ถ๐—ผ๐—ป๐˜€." ๐—ฃ๐—ฒ๐—ผ๐—ฝ๐—น๐—ฒ ๐˜„๐—ถ๐˜๐—ต ๐—บ๐˜‚๐—น๐˜๐—ถ๐—ฝ๐—น๐—ฒ ๐—น๐—ถ๐—ฐ๐—ฒ๐—ป๐˜€๐—ฒ๐˜€ ๐—ฑ๐—ผ๐—ป'๐˜ ๐—ต๐—ฎ๐˜ƒ๐—ฒ ๐˜๐—ผ ๐˜€๐—ถ๐—ด๐—ป ๐˜‚๐—ฝ ๐—บ๐˜‚๐—น๐˜๐—ถ๐—ฝ๐—น๐—ฒ ๐˜๐—ถ๐—บ๐—ฒ๐˜€.To learn more about RACEtrack, visit aavsb.org/RACEtrack.โ€ RACETrack. If you will not ever need proof of CE attendance, plase put NA in each field below.
License Number *
๐—ง๐—ต๐—ฒ ๐—ฎ๐˜๐˜๐—ฒ๐—ป๐—ฑ๐—ฒ๐—ฒ ๐—ผ๐—ป๐—น๐˜† ๐—ป๐—ฒ๐—ฒ๐—ฑ๐˜€ ๐˜๐—ผ ๐—ฝ๐—ฟ๐—ผ๐˜ƒ๐—ถ๐—ฑ๐—ฒ ๐—ผ๐—ป๐—ฒ ๐—น๐—ถ๐—ฐ๐—ฒ๐—ป๐˜€๐—ฒ ๐—ป๐˜‚๐—บ๐—ฏ๐—ฒ๐—ฟ ๐˜๐—ผ ๐˜๐—ฟ๐—ฎ๐—ฐ๐—ธ ๐˜๐—ต๐—ฒ๐—ถ๐—ฟ ๐—–๐—˜, ๐—ฒ๐˜ƒ๐—ฒ๐—ป ๐—ถ๐—ณ ๐˜๐—ต๐—ฒ๐˜† ๐—ฎ๐—ฟ๐—ฒ ๐—น๐—ถ๐—ฐ๐—ฒ๐—ป๐˜€๐—ฒ๐—ฑ ๐—ถ๐—ป ๐—บ๐˜‚๐—น๐˜๐—ถ๐—ฝ๐—น๐—ฒ ๐—ท๐˜‚๐—ฟ๐—ถ๐˜€๐—ฑ๐—ถ๐—ฐ๐˜๐—ถ๐—ผ๐—ป๐˜€." ๐—ฃ๐—ฒ๐—ผ๐—ฝ๐—น๐—ฒ ๐˜„๐—ถ๐˜๐—ต ๐—บ๐˜‚๐—น๐˜๐—ถ๐—ฝ๐—น๐—ฒ ๐—น๐—ถ๐—ฐ๐—ฒ๐—ป๐˜€๐—ฒ๐˜€ ๐—ฑ๐—ผ๐—ป'๐˜ ๐—ต๐—ฎ๐˜ƒ๐—ฒ ๐˜๐—ผ ๐˜€๐—ถ๐—ด๐—ป ๐˜‚๐—ฝ ๐—บ๐˜‚๐—น๐˜๐—ถ๐—ฝ๐—น๐—ฒ ๐˜๐—ถ๐—บ๐—ฒ๐˜€.To learn more about RACEtrack, visit aavsb.org/RACEtrack.โ€ RACETrack..
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