1.  Please print this page,
2.  Checks payable to IAFFV preferred; or include credit card information
3.  Mail application and payment to :

Dr. Don Sawyer
President, IAFFV
2031 Tomahawk Rd
Okemos, MI 48864

Name_____________________________________________________________________

Address___________________________________________________________________

City __________________________________ State ____________  Zip _____________

E-Mail address _____________________________________________________________

Phone____________________________________ Fax_____________________________

Method of Payment :  Include Zip Code for Credit Card Address

· Check Preferred - payable to: IAFFV
· Visa
· Master Card

Credit Card Number:__________________________________________________________

Expiration Date_______________________________________________________________

Zip__________________________

Amount $ ____________________

Signature____________________________________________________________________

How did you hear about us?

Web-Site         JAVMA           Another Member

Other__________________________________

BACK