Membership Application Form

Select your membership option*

Student

Professional

First name*

Last name*

Email*

Address

Birthday

Month

Day

Year

Website if you have one

If applying for student membership, list the name of your school, program or training provider.

If applying for student membership list the program or course of study.

Enrollment start date

Expected completion date

Are you able to provide proof of enrollment if requested?

Yes

If applying for professional membership list your title and credentials.

What is your primary modality or area of practice?

How many years have you been in practice?

Primary species served.

Please describe your professional experience, services and qualifications.

Do you currently hold professional liability insurance if applicable in your jurisdiction?

Yes

I agree to uphold IAHAP ethical standards and professional conduct requirements.

I understand that membership may be reviewed, approved, denied, or revoked based on IAHAP policies and standards.

I agree to represent my training, services, and credentials truthfully.

I understand that IAHAP membership does not authorize me to practice outside my legal scope or replace veterinary care.

If approved, would you like to be considered for inclusion in the IAHAP directory?

Yes

Name as you would like it to appear publicly.

Public website or social link for listing.

Short public description for your directory listing.

Please provide a professional photo and/or logo for your listing.

386-341-6948

330 Spring Forest Drive
New Smyrna Beach, FL 32168

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