Maryland Society of Health-System Pharmacists Application

MSHP helps you stay in touch with our changing environments, learn new skills, identify opportunities, make contacts and advance your career. How? By participating in our monthly meetings where you can meet colleagues, share ideas, and gain up to 25 hours of ACPE approved education yearly. Additional opportunities are available through participation on one of our many committees.

I want to join MSHP. (Please check appropriate box and remit proper amount.)

Active Member Dues $78.00

(licensed pharmacists who have an interest in health-system pharmacy practice.)

New Graduate Member Dues $48.00

(licensed pharmacists who have graduated from a five or six year school of pharmacy in last calendar year.)

Student Chapter

(individuals currently enrolled in an entry level program at a School of Pharmacy can join the student chapter by contacting the MSHP office for a student chapter application. Student chapter members are welcome to participate in all MSHP functions.)

Pharmacy Resident Member Dues $ 36.00

(individual currently enrolled as a Pharmacy Resident)

Pharmacy Fellow Member Dues $ 36.00

(individual currently enrolled as a Pharmacy Fellow)

Associate Member Dues $78.00

(individuals who work as representatives in related companies, inspectors of health-system pharmacies or instructors of prospective health-system pharmacists)

Pharmacy Technician/Ancillary Member Dues $36.00

(includes other personnel working in a health-system pharmacy)

Senior Member Dues $60.00

(current or previously licensed pharmacists of age 60 or greater)

Payment Amount: $

I understand that I will be invoiced for this amount and payment by check is required.

Please Note: Dues are prorated at 66% from July through October each year. Dues received after October 31 are applied to the following calendar year. MSHP dues are not deductible as a charitable contribution under the Internal Revenue code, but may be deducted under other provisions of the Code. MSHP now also accepts American Express as a form of payment.

Personal Data

Name:

Preferred Address:

City: State: Zip:

Daytime Phone:

Alternate Phone:

FAX:

E-mail Address:

Institution:
Practice Setting: ASHP Member:
Committees of Interest:

I would be willing to contact my state representative or senator in writing or by phone for legislative issues of importance to MSHP.
(If yes, MSHP would contact you with information about the issue and allow you to choose the mode of communication.)

Please indicate legislative district here (if known)

Recruited by: Date: