strengthening the veterinary

regulatory community

AAVSB Service Application - MyAAVSB VetTech Account

If you already have a MyAAVSB account, please sign in above.

* Indicates required field.

Personal Information *
First Name *
Middle Name
Last Name *
Suffix
Other Names Used?
(maiden name, nickname, etc)
Last 4 digits of SSN/SI.
(0000 if no SSN/SI) – "Ex. 1234”
*

Gender
Date Of Birth
mm/dd/yyyy
*  
Place Of Birth (city/state or province) *
Contact Information
Home Phone
eg., 999-999-9999
   
Work Phone    
Cell Phone    
Email Address *
Re-enter Email Address *
NOTE: All our communication will come to you via EMAIL!
Address (U.S. or Canadian, if possible)
Address *
Address 2
City *
State or Province *
ZIP/Postal Code *
Country *
Alternate Address
Address
Address 2
City
State or Province
ZIP/Postal Code
Country
Notes
Special notes about this application
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* AAVSB Requests your personal information including Social Security number or Canadian identification number and e-mail address for identification only. This information is not included on AAVSB reports and is not shared with other entities. Without sufficient identifiying information, AAVSB may be unable to comply with your request(s) for services.