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PEIVMA

PEIVMA

Prince Edward Island Veterinary Medical Association

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Short Term Application

 Prince Edward Island Veterinary Medical Association Application for Short-Term Membership & Licence 

Short-Term Membership & Licence

  • MM slash DD slash YYYY
  • The PEIVMA corresponds with its members by email. Provide your current email address. In doing so, you agree to accept correspondence from PEIVMA via email.
  • I DO SOLEMNLY DECLARE THAT:

  • I graduated with a degree in Veterinary Medicine from:

  • I have obtained the following other degrees:

  • The facility in which I intend to practice will be an accredited facility.

  • MM slash DD slash YYYY
  • I am familiar with the Prince Edward Island Veterinary Medical Association (PEIVMA) Act and Bylaws and do solemnly declare my willingness to uphold the honour and dignity of the profession, that I will undertake to practice veterinary medicine in a professional and becoming manner and in accordance with the Act and Bylaws of the PEIVMA including any and all restrictions imposed by said Act and Bylaws, and that my name has not been removed from the register of any veterinary association by reason of an indictable offence. The information in this application is correct to the best of my knowledge, information and belief, and I understand and agree that, in the event that any information provided above is incorrect, the PEIVMA may suspend or cancel any registration or license granted by it. I also hereby authorize the Prince Edward Island Veterinary Medical Association (PEIVMA) to make those inquiries that it deems relevant to my application for membership and licensure in the PEIVMA from those educational institutions that I have attended and those professional associations of which I am or have been a member. I also hereby authorize those educational institutions and professional associations to provide to the PEIVMA all such information requested by it. The Prince Edward Island Veterinary Medical Association (PEIVMA) communicates with its members primarily through electronic means (e.g. email, electronic newsletters, etc.) I agree to accept electronic communications from the PEIVMA (express consent) and I will contact the PEIVMA office to unsubscribe should my wishes change in this regard.
  • Reset signature Signature locked. Reset to sign again
  • MM slash DD slash YYYY
  • As Sponsoring Veterinarian, I, declare that I understand and accept the responsibilities as outlined in the Association Bylaws and agree to accept liability for the applicant, both in relation to the Association and the clients with whom the applicant comes into contact, and that I will be responsible for continuing after the applicant leaves Prince Edward Island any veterinary care started in Prince Edward Island by the applicant.
  • Reset signature Signature locked. Reset to sign again
  • MM slash DD slash YYYY

An additional rush fee of $150.00+HST ($21.00) will be applied to applications requiring approval less than 3 weeks prior to start date. 

A minimum of five business days must be given for processing. 

Failure to provide all required documentation and fees will delay approval of application. 

Forward complete application package with associated fees to Registrar, PEIVMA, Box 21097, 465 University Avenue, Charlottetown, PE, C1A 9H6 

Please provide written notice to the registrar of resignation from the PEIVMA . 

465 University Avenue
Box 21097
Charlottetown, PE C1A 9H6

admin@peivma.ca
902-367-3757

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