Membership Application

Membership Categories Include:

  • Active: Open to all certified, registered or licensed persons ($35 application fee)
  • Associate: Open to all persons interested in supporting and promoting the Association; assistants, Veterinarians, Receptionists, etc. ($35 application fee)
  • Student: Open to any student actively enrolled in an AVMA accredited Veterinary Technician Program ($20 application fee). Take me to the Student Membership Application!
  • 1st Year PIMA Student: Open to any student new to the Dillon Veterinary Technician Program. FREE for the first year! Take me to the PIMA Student Membership Application!

Membership Category -- Select One

Full Name

Your Email

Your Phone

Home Address (include state & zip)

Place of Employment

Work Address (include state & zip)

Work Phone

Please select one of the following that best suits your current position:

Small AnimalLarge AnimalMixed PracticeExoticsLaboratory/ResearchOther

Please select ONE of the following membership types:

Renewal MembershipNew Membership

If this is a renewal, has your information changed from last year? Yes or no?

If this is a new membership, please provide the school you attended and your year of graduation:

If this is a new membership, please email a copy of your of your diploma from a 2 year program as well as your VTNE score to You will also need to provide a statement from your previous state of residence (if applicable), which indicates that you are in good standing and select from the list of three license options below.

License Information (Scroll to select Licensed, Certified or Registered)

Issuing State

License Number

PLEASE NOTE: This form is for BSVTA Membership only. To become Certified in the State of Montana, please fill out a separate application form.

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