WVPA

WVPA (India)

Registration Form

Title:

Qualification:
(Tick relevant Degrees)

B.V.Sc. & A.H. M.V.Sc. Ph.d Degree other than (B.V.Sc. & A.H.)

VCI No.(optional):

Family Name:

Forename:

Designation:

Institution:

Address:

Village/Town/City:

Pincode:

District:

State:

Country:

Mobile Number:

Fax Number(Optional):

Landline no.(Optional):

Email:

Membership Fees:

This box is for applications for Associate Members ONLY

Proposer:

Seconder:

Please ask your Proposer and Seconder to send brief emails of support

How would you describe your main activity ( tick one )

General Practice

Teaching

Pharmaceutical Company

Private Practice

Research

Other(please specify)

Poultry Company Vet

Feed Industry

Please ask your Proposer and Seconder to send brief emails of support