| A P P L I C A T I O N F O R M E M B E R S H I P |
❑ Annual dues: $75.00 (includes CE Broker)
❑ Students: $FREE
❑ Technicians: $30.00
❑ Individual Meeting: $25.00 |
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PLEASE PRINT:
Send application along with your check
NAME___________________________________________
ADDRESS________________________________________
CITY________________________ STATE____ ZIP_______
PHONE (W)________________ (H)___________________
EMAIL ADDRESS____________________________________
Send to Florida Pharmacy Foundation
Alan Katz, Executive Director
Broward County Pharmacy Association
4909 Adams Street
Hollywood, FL 33021
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