MEMBERSHIP APPLICATION
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
LECOM Email
*
example@example.com
Pharmacy Pathway and Class of:
*
Please Select one *($10 of your dues will go towards your FSHP State membership):
*
FSHP-SC LECOM Bradenton NEW MEMBER. $30
FSHP-SC LECOM Bradenton RENEWED MEMBER. $27
PAYMENT
Make checks payable to: LECOM-Bradenton FSHP-SC Please give checks to Treasurer: Alesia Neloms *You can pay via other methods by contacting treasurer for more information. Venmo: @Alesia-Neloms Email: ANeloms68737@rx.lecom.edu
** Optional: American Society of Health System Pharmacists (ASHP)
FREE for P1 students
$54.00 membership for (P2-P4 students)
ASHP Student Forum
ASHP Section of Clinical Specialists
ASHP Section of Home, Ambulatory, and Chronic Care
ASHP Section of Inpatient Care Practioners
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