Spring USC APSA Membership Application 2017-2018 (P1)

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Deadline: February 28, 2018 at 11:59 pm

Complete Membership Registration Instructions, including APhA online payment can be found at these following locations:
On the Website: http://uscapsa.org/membership/
Google Doc: https://docs.google.com/document/d/1ESWQqzZkGuAm6-P1dU0yjCsRFQK8RiGNb644tMQTJms/edit?usp=sharing

REGISTRATION STEPS

1) Complete the electronic APSA application. (This application)

2) Submit your check (To any executive board member) for membership payment made out to “APSA” or Venmo to the Director of Financial Affairs @USC-APSA

3) Write in the memo section of the payment if you are applying for Dual Membership, APhA/CPhA/IPSF Single Standard, or ASHP/CSHP Single Standard

Dual Membership: $45 online (APhA) and $140 check/venmo (APSA)
APhA/CPhA/IPSF Single Standard: $45 online (APhA) and $65 check/venmo (APSA)
ASHP/CSHP Single Standard: $110 check/venmo (APSA)

*Only renewing/returning members are eligible for Single Standard Membership*

4) After you register for APhA please e-mail the receipt confirmation to Jenny Thao Huynh at thaohuyn@usc.edu

[NOTE] P1 and P2 members MUST part take in at least one committee to complete the requirements to be an ACTIVE member.
More information on each committees can be found in the Committee Manual linked here: https://www.flipsnack.com/uscapsa/apsa-committee-manual.html

For any further membership questions please contact the Director of Membership, Jenny Thao Huynh.

First Name *

Last Name *

USC Email *

Non-USC Email *

Phone Number (XXX-XXX-XXXX) *

Residential Street Address *

Residential City *

Residential Zip Code *

Date of Birth *

YYYY

Gender

Clear selection

Graduation Year *

2021

California Intern License Number *

Membership Type *

Dual Membership $185 Total [$45 online (APhA) and $140 check/venmo (APSA)]

Primary ASHP Section Choice *

Clinical Specialists and Scientists

Ambulatory Care Practitioners

Inpatient Care Practitioners

Pharmacy Practice Managers

Pharmacy Informatics and Technology

Additional ASHP Section Choice *

Clinical Specialists and Scientists

Ambulatory Care Practitioners

Inpatient Care Practitioners

Pharmacy Practice Managers

Pharmacy Informatics and Technology

APSA Committee Selection (Minimum of 1 REQUIRED for P1 and P2) Details on the Committees can be found in the Committee Manual linked above. *

Asthma Awareness

Body Fat Analysis

Cholesterol Awareness

Generation RX

Healthy Living/Alternative Medicine

Indian Pharmacist Association

Infectious Disease Awareness

International Affairs

Legislative Affairs

Operation Diabetes

Operation Immunization

OTC/Medication Safety

Pain Management

Poison Prevention

Project Hypertension

Smoking Cessation

Student Helping and Receiving Education (SHARE)

Required

Payment Method *

Check made out to "APSA" (Given to any Executive Board Member)

Venmo to the Director of Financial Affairs @USC-APSA

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