Academy of Veterinary Dental Technicians

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This form is for the AVDT Mailing List only, not AVDT membership.

First Name		Last Name
Street Address
City		State	Zip
Phone		Work Phone
E-Mail

Clinic Name
Clinic Street Address
City		State	Zip

Tech Program Attended
Year Graduated
Professional organizations you are a member of:
	I am interested in becoming a member of the Dental Technician Society