CONSERVATION PROJECTS FORM
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Association of Avian Veterinarians

Conservation Committee

Member Conservation Projects List

Submission Form

 

Member Information

This is information about you, the participant, in this project. If you don’t wish to be contacted about the project, check here ¨ to not have your contact information listed.

 

Name:________________________________________ Affiliation:______________________________________

Address:_____________________________________________________________________________________

Phone(s):____________________________________________________________________________________

E-Mail:________________________________________ Website:______________________________________

Position/Job Title with Project:___________________________________________________________________

Describe time commitment, experiences, and years involved. Use back of form if necessary:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

 

Project Information

This is who people should contact for more information about the project. Fill out as much information as you think is pertinent. For instance, a website can be a secure and consistent way for people to find out more about the project and its goals.

¨ Check here if contact information is same as above

Title for Project/Activity:________________________________________________________________________

Contact Name:_________________________________ Organization:___________________________________

Address:_____________________________________________________________________________________

Phone(s):____________________________________________________________________________________

E-Mail:________________________________________ Website:______________________________________

Region where conducted:_______________________________________________________________________

Species emphasis:____________________________________________________________________________

Organization/Project Description:_________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Please copy form to your e-mail and e-mail complete forms to akeaglevet@yahoo.com.