Basic student member application form

Use this form to apply for AVA membership if you're currently enrolled as a veterinary science student in an AVA recognised Australian university. If you are unsure, please contact AVA national office on 1300 137 309 or members [at] ava [dot] com [dot] au.

This form will take approximately 5 minutes to fill out.

Mandatory fields are marked with a red asterisk

What made you decide to become an AVA member?: *

Please complete your personal details on the form below. All mandatory fields are marked with a red asterisk.

1. Personal Details

Prefix:

First Name: *

Type your first name in here

Middle Name:

Enter your middle name here

Last Name: *

Enter your last name in here

Date of Birth: *

Enter your date of Birth

Gender: *

2. Degree

University: *

Select your university.

Degree: *

Please select the undergraduate degree you are currently studying for.

Year: *

Your year of study in your current course.

3. Contact Details

Please enter your contact details below.

Home Phone:

Enter your home phone number. Please include area code

Work Phone:

Enter your work phone number here. Please include area code

Fax:

Enter your fax number here. Please include area code

Mobile: *

email: *

Enter in your email address

4. Postal Details

Please complete your postal address

Postal Street Address: *

Type in the postal address you want items to be mailed to.

Postal Suburb: *

Type in your postal city / suburb

Postal State: *

Select the state you belong to

Postal Postcode: *

5. Residential Details

Same as postal address:

My postal address is the same as my residential address

Please complete your residential address.

Residential Street Address:

Type in the street address that you currently live in.

Residential Suburb:

type in the the suburb / city that you live in

Residential State:

Select the state you belong to

Residential Postcode:

6. Declaration

Agree to the AVA Rules and Constitution: *

Yes I agree

Privacy Statement The AVA is committed to maintaining the confidentiality and security of the personal information we hold in accordance with the Privacy Act 1988. Your personal information is collected so we can communicate with you and provide services to you.

Your details may be used to communicate with you about products and services provided by affiliated organisations that your membership entitles you to. You should notify us if you do not want us to use your information in this way, but please be aware that you may not enjoy the full benefits of membership of the AVA if you do this.