You may fill out this form online and then print and mail the information along with your payment to Spokane Pharmacy Association, PO Box 2591, Spokane, WA 99220. Please provide name, address, email address, and phone number for each person.

50 year-pharmacists may also email this form by using the submit button and may donate to the Scholarship Fund by returning to the Membership page.

Note: The Newsletter will be sent via e-mail.

Name(s):          

Email address:            Please enter a valid email address

A value is required.The values don't match.

Address:

Street
 

City
 

State
 

Zip Code

Home Phone:

Work Phone:

Job Title Qty Cost
Practicing Pharmacist

$50.00

Pharmacy Technician

$25.00

Retired Pharmacist

$25.00
Associate Member (includes pharmaceutical reps and other non-pharmacists)

$50.00

Student, Pharmacist      Year Graduating:

$10.00

Student, Technician      Year Graduating:

$10.00

50 Year Pharmacist

FREE

Scholarship Fund Donation

   $ 

Two members in same household subtract $5.00 per member.
  $-
     
 

Total

   $

50-year pharmacists may use the submit button to send your information.