Prairieland Visiting Animal Association Membership Form

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Email *

First and Last Name *

Phone Number *

Please write in xxx-xxx-xxxx format

Street Address *

City *

State *

Zip Code *

Your Birthday (year not required!)

Month/Day (00/00)

Tell us about yourself and your interests. (place of employment, hobbies, family members, how you became interested in PVAA, etc) *

***Box will expand as you type.

Tell us about your animal(s). (name, breed, year of birth, gender, color, weight, favorite toy/activity, ) *

***Box will expand as you type.

Which national therapy animal organization are you registered through or planning to register through?

Pet Partners

Alliance of Therapy Dogs

Clear selection

We collect photos of our members with their animals. Please follow directions below. *

Either take a photo or use one you already have of YOU WITH YOUR ANIMAL. Email it to socialmedia@pvaatopeka.org.

Check this box if you consent to having photos of you and your animal posted on the PVAA Facebook and Instagram social media sites. Please note that these posts use only first names and you are not "tagged".

Required

Dues are $30 a year. Dues are prorated if you are new to PVAA and join after February. Please refer to the following chart for how much you owe for dues depending on what month you are joining: *

PayPal: After you submit this form a PayPal payment page will come up for you to pay your dues.

Check: Make payable to "PVAA" and send to PVAA, PO Box 3836, Topeka, KS 66604

I already paid

Required

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