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Group Membership Change Request

Changes to members must be authorized by company’s designated primary contact. By submitting this form, the primary contact confirms that all information provided is accurate & true and any newly added members conform to the terms and conditions of IAVM Group Membership. If a new member is added, he or she will receive instructions to create his/her unique member password to review their member profile. This review is required within two weeks of activation.

Membership Type*
Action Required*
Select one of the above actions.

Remove Member

First Name
Reason for Removal

We provide members no longer part of a group membership the opportunity to transition back to individual membership and retain access to benefits and their member join date. Any forwarding contact information would assist IAVM in this effort.

Add Member

To ensure members are connected with the right communities and get the most out of their memberships, please indicate if additional members listed below fall into one of these categories by checking the appropriate box.

Name
CVE, CVP, CEM, etc.
Additional Attribute - Allieds
Birth Date
Please include for Young Professionals and Students
Additional Attribute - Professionals

Signature

Must be authorized by company’s designated primary contact

Use your mouse or finger to draw your signature above
Questions? Contact Member Care Manager, robin.covington@iavm.org or call (800) 935-4226.