Relief Pharmacists Sign-up
This sign-up form is for pharmacists who would like to be contacted when there is relief work available in Kansas. This information will be shared with companies and individuals who are seeking a pharmacist's help. If you have questions regarding the form, please call the KPhA office at 785.228.2327 or email info@ksrx.org. Thank you.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
I'm available for work in the following practice settings:
*
Hospital/Health System
Community Pharmacy
Long-term Care
Other
With which software systems are you familiar?
*
For example Cerner, QS/1, Computer Rx, etc.
By selecting YES, you acknowledge you are a Kansas-licensed pharmacist in good standing.
*
YES
Submit
Should be Empty: