Illinois State Veterinary Medical Association | 1121 Chatham Road Springfield, IL 62704

    Volunteer Interest Form



    Gender

    MF

    Present working status (select one)

    Full TimePart TimeInactiveWorking in another field

    Setting of professional activity (select one)

    Hospital or Clinic (ie private practice)*FarmCollege or UniversityBusiness or IndustryPublic HealthAdministration/Regulatory

    *Type of private practice (select one)

    Small Animal (canine or feline exclusive?)Mixed AnimalLarge AnimalBovine Exclusive (diary or beef exclusive?)EquineSwineLab AnimalExotic/Zoo Animal

    Have you previously served as an ISVMA volunteer?

    YesNo

    Have you ever attended the ISVMA convention?

    YesNo

    Volunteer Interests (please check as many as apply)

    Committees/Leadership

    Legislative CommitteeMembership CommitteeNominations & Awards CommitteeEducation Planning CommitteeMuseum & History CommitteeFinance/Audit CommitteeExhibitor Relations CommitteeSponsorship CommitteePublic Relations CommitteeVeterinary Profession Task Force CommitteeGovernance Task Force CommitteeBoard of DirectorsOfficer (President, Vice-President, President-Elect, Past President, Treasurer)Illinois Veterinary Medical Foundation

    Convention

    Moderator

    Student Relations

    Mentor

    Legislative

    Grassroots advocateLobby Day Participant