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AASHP 2008 Membership Form

Dues:
  • Pharmacist: $35.00
  • Technician: $20.00
  • Student: $15.00

How would you like
to join/renew?

       Directly through AASHP
I am joining/renewing AASHP
            through TSHP

 
If you are joining or renewing AASHP directly, please send your check to the address on the confirmation page that you will see after you fill out this form (or bring a check to the next meeting).  If you joined or renewed AASHP through TSHP, please fill out this form to be included in our membership database.

Be sure to also join the AASHP email announcements list--filling out this form will NOT place you on the list.  To sign up, click here -- a new window will open.  Meetings are announced by email to announcement list subscribers.

To join AASHP through TSHP, click here to download and print
the TSHP membership application (but please also fill out and submit the form below and also join the announcement list.)
First Name
Last Name
Birth Date (mm/dd/yyyy)
Title BS Pharm
MS
Ph.D.
Pharm.D.
CPhT
Technician Trainee
Pharmacy Student
Other
Mailing Address
City
State  
Zip Code
Your Email Address

How do you prefer to receive information on AASHP events?

 E-Mail
Website
Postal Mail
Home Phone (with area code)
Place of Employment
Position Held
Daytime Phone Number
(with area code)
Are you a TSHP Member? Yes
No
Membership Category
(choose one)		  Active Member (dues: $35)
 Technician (dues: $20)
 Student (dues: $15)
 
I am interested in helping
with these activities:
(please check )		 Spring Seminar Planning Committee
Community Projects
         (Texas Pharmacy Week, etc.)
Volunteer Clinic
Anything!

I would like to see the following topics offered as CE Programs
1.
2.
3.

Comments (Optional)

 
 
 

Copyright (c) 2008 Austin Area Society of Health-System Pharmacists
PO Box 685136 Austin, Texas 78768

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