APhA-ASP Membership Form
DUE OCTOBER 15th
Name: Click here to enter text.
Graduating Year: Click here to enter text.
Rutgers NetID: Click here to enter text.
Preferred Email: Click here to enter text.
Which committees would you like to learn more about?
Operation Healthy Heart
Operation Self Care
Operation Immunization
Operation Diabetes
Smoking Cessation and Healthy Lung
Trooper Turtle
Generation Rx
NJPhA
Shadow a Pharmacy Student (SAPS)
Policy Committee
Professional Affairs
Finance Committee
International Pharmaceutical Students’
Federation (IPSF)
Patient Counseling Competition
Marketing Committee
Optional
Phone Number: Click here to enter text.
Campus PO Address: Click here to enter text.
What are you looking to get out of APhA?
Click here to enter text.
Rutgers APhA-ASP Chapter Dues:
$10 (REQUIRED)
NJPhA State Dues:
$10 (REQUIRED)
APhA-ASP National Dues:
$45 (REQUIRED)
To pay ALL dues log in or register via http://tinyurl.com/APhADues
>> Do NOT $65 to this form
Hand this form to any APhA E-Board Member or Class Officer,
drop it off in the APhA mailbox in the Pharmacy Lounge
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Learn more about membership benefits at www.rutgersapha.com
If you have any questions, please email rutgersaphaasp@gmail.com