2016 AVMA PLIT Student Professional Liability Coverage Application

You must be a member of the Student AVMA (SAVMA). Coverage starts the day following receipt of the application in our office.

Note: Please allow up to 5 business days for receipt of your personalized coverage confirmation.

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* 1. Student First and Last Name:

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* 2. SAVMA Number:

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* 3. Email Address:

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* 4. Telephone Number:

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* 5. Address:

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* 6. City, State, and Zip Code:

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* 7. School:

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* 8. Anticipated Graduation Date:

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* 9. Coverage terminates January 1, 2017.

I understand