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Individual Membership Application

If you are or were previously an AVA member, please enter your Member Name and Password and click the Remember Me button below. If you don't remember your Password/Member Number click here to contact the AVA office via email.
User Name:    Password:

If you have your VA-BC you must update your information separately on the VACC web site www.vacert.org

Please complete this application.
    
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INFORMATION
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EMPLOYER TYPE (CHECK ONE)
Alternate Site Home Infusion
Hospital Industry
Home Health Long-Term Care
Other:
 

PROFESSION (CHECK ONE)
Nurse Pharmacist
Administration / Management Sales
Physician: Speciality:
Other:
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Friend or Colleague(please list):
AVA National Conference
Other conference you attended (please list):
Local AVA network (please list):
JAVA
Other (please specify):
 

If you are a network member please supply your network code below to receive your discount. If you don’t know the Network Code, please contact your network leader before completing this transaction.
Network Code:   
If you have a special discount promotion code please supply your code below.
Special Discount Promotion Code:   
ANNUAL DUES (CHECK ONE)
AVA dues are not deductible as charitable contributions for tax purposes. Consult your tax advisor, as they may be deductible under sections of the tax code. Membership is renewed at the same time each year at the end of the month you originally joined.
Yes, I want to join AVA for 1 year @ $110 USD (includes online discount of $5.00) }
Special Rate: 2 year renewal $210 USD (includes online discount of $20.00)
Special Rate: 3 year renewal $305 USD (includes online discount of $40.00)
 

OTHER OPTIONS
I want to subscribe to the online version of the quarterly Journal of Vascular Access (JVA) for one year at the special AVA membership discounted rate of $60 USD. This would be in addition to The Journal of the Association for Vascular Access (JAVA); which is free with my paid AVA membership. JVA is a worldwide peer-reviewed and scholarly research journal covering all aspects of vascular access. Click here for more information about JVA.
 

PAYMENT OPTIONS
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Privacy Notice - AVA respects the privacy rights of all individual members. Select information submitted on your membership application is published on our online AVA Membership Directory. If any individual member does not want their membership information published, that individual should forward a written request to be omitted with their application or by letter to AVA, 5526 W 13400 S Ste #229 Herriman, UT 84096, or fax to 801-601-8012.