To submit a membership application:
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1.  Please print this page,
2.  Make checks payable to IAFFV or include credit card information
3.  Mail application and payment to :

WALTER E. WEIRICH, DVM, PhD
7957 WEST JUNIPER SHADOWS WAY
TUCSON, ARIZONA 85743

Name_____________________________________________________________________

Address___________________________________________________________________

City __________________________________ State ____________  Zip _____________

E-Mail address _____________________________________________________________

Phone____________________________________ Fax_____________________________

Method of Payment :  Include Zip Code for Credit Card Address

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Expiration Date_______________________________________________________________

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Amount $ ____________________

Signature____________________________________________________________________

 

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