Certification Name Change Application

Certification Renewals are not due until December 31 and will require proof of 16 hours of CE. 

Please fill out the application below. You can submit the form digitally as well as submit your payment via PayPal. There will be a link in the confirmation window after you submit your form that will take you to our PayPal portal. If you prefer to fill out a hard copy of the application and mail a check, the instructions for how to do so are on the bottom of this page.

The name change application fee is $10.00.

    Your Name

    Your Email

    Your Phone

    Home Address (include state & zip)

    Place of Employment

    Work Address (include state & zip)

    Work Phone

    Please note: This form is for Certification Name Change only. To become a member of BSVTA please fill out our member application form.

    Print the 2021 Certification Application

    Printed application Instructions:

    •  Fill out and sign the application
    • Make check payable to BSVTA:
      o New certification Fee: $75
      o Renewal Certification Fee: $75 (postmarked before Dec 31 st )
      o Late Renewal Certification Fee: $100 (postmarked after Dec 31 st )

    Return all documentation to:

    BIG SKY VETERINARY TECHNICIAN ASSOCIATION c/o Marcia Cantrell, CVT 6 Stallion Ridge Livingston, MT 59047

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