CORE: NCPA Leadership Program Enrollment Form
Through our Change, Optimize, Revitalize, and Energize methodology, CORE empowers you, your team, and your business to operate and grow successfully. The key to thriving amidst challenges lies in what you can control. CORE helps you harness that control and drive meaningful change within the fundamental areas of your business. Please complete the following enrollment form carefully.
Your Name
*
First Name
Last Name
Your Position
*
Please Select
Store Owner
Pharmacy Manager
Pharmacy Technician
Other
Your Email
*
example@example.com
Your Mobile Phone Number
*
Please enter a valid phone number.
Are you enrolling yourself in CORE or an employee?
*
Myself
Employee
Employee Name (whoever will be participating in CORE)
First Name
Last Name
Pharmacy Name
*
Pharmacy Owner
*
First Name
Last Name
Pharmacy NCPA Member ID Number
*
Pharmacy Phone Number
*
Please enter a valid phone number.
Pharmacy Website
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Local CPESN Network
Select the eCare Plan capable system provided to pharmacy employees.
*
Please Select
Amplicare
Assurecare
Azova
BestRx
ComputerRx
Datascan
DocsInk
DocStation
FDS
habitnu
Liberty
McKesson
OmniSYS
Parmetika
PioneerRx
PrescribeWellness
PrimeRx
QS/1
Rx30
Other
Primary Wholesaler
*
Please Select
AmerisourceBergen
Cardinal Health
McKesson Corp
Mutual Drug Co
Smith Drug Co
Other
Pharmacy Software Provider
*
Please Select
PioneerRx
ComputerRx
Liberty
Rx30
QS/1
Other
Select the date range that represents the year you graduated from pharmacy school.
*
2025
2017-2024
2006-2016
Before 2005
Which time zone are you located in?
*
Eastern Time
Central Time
Mountain Time
Pacific Time
Alaska Time
Hawaii Time
Professional Headshot
Browse Files
Drag and drop files here
Choose a file
High resolution files are preferred.
Cancel
of
Why do you want to participate in CORE and what do you hope to accomplish?
*
Describe your experience working with and leading teams.
*
Your Signature
*
Date
*
-
Month
-
Day
Year
Date
Payment Information
The exclusive introductory rate for the inaugural cohort is $699 per month, a monthly savings of $200 off our regular rate of $899 per month. Participants can choose to make monthly payments or pay an upfront, further discounted rate of $8,000. Tuition for the program is nonrefundable. Enrollment in the program constitutes a 12-month commitment, with the option to renew thereafter. You will not be automatically renewed or charged beyond that commitment without your consent. *We recommend creating a PayPal account when you submit payment, in the event you need to update your payment method in the future.*
Payment Options
*
prev
next
( X )
CORE - Discounted, Annual Payment Option
Save an additional $388 when you pay for the entire year upfront.
$
8,000
for each
year
CORE - Monthly Payment Option
Total payments over the course of the year will equal $8,388.
$
699
for each
month
Submit Application
Clear Form
Should be Empty: