President's Message Contact PPSSFV.org Apply Online Printable Application Printable Application Members Directory For a list of Pharmacists' Professional Society of the San Fernando Valley board members, officers, and store locations, please check the directory CPhA is working hard to listen to pharmacists across the state. We are committed to making this a nonprofit association serving the entire profession of pharmacy. With numbers, CPhA can defend and advocate the profession of pharmacy. Become a member today and help in that fight, while enjoying the benefits of membership. Please print out this page, complete it, and return by fax (916) 779-1401 or mail to: California Pharmacists Association Membership Division 4030 Lennane Drive  Sacramento, CA  95834 Date: ____ / ____ / ____                   CA Lic # ____________ (Check one) Mr. ___ Mrs. ___ Ms. ___ Dr. ___ Other _________________ Name: _____________________________________________________ Home Address: ______________________________________________ City, State, Zip: _______________________________________________ Home Phone: (____)_____________ Home Fax Number: (____)_____________ Home E-mail address: ___________________ Work Address: ______________________________________________ City, State, Zip: _______________________________________________ Work Phone: (____)______________ Work Fax Number: (____)_____________ Work E-mail address: ___________________ Preferred Mailing Address (check one): Work ____ Home ____ Highest Degree (check one): B.S. ____ Pharm.D. ____ M.S. ____ Ph.D. ____ Graduation Date for Highest Degree: ____ / ____ / ____ Referred By:_______________________________ Membership Selection ____ Pharmacist Member … $290.00 ____ Associate (non-pharmacist/sales reps.) … $125.00 ____ Associate with optional Local … $150.00 ____ Pharmacy Technician … $75.00 ____ Pharmacy Technician with optional Local … $100.00 ____ 1st Year Graduate … $90.00 ____ 2nd Year Graduate … $205.00 ____ Pharmacy Resident … $90.00 1 FREE Academy Membership: Please designate which academy you wish to be placed in. (Pharmacists only) ____ Pharmacy Owners ____ Employee Pharmacists (subselections: ____ Manager or ____ Staff) ____ Long Term Care ____ Hospital Pharmacists ____ Pharmacy Students ____ Pharmacy Specialties (subselections: ____ Academician, ____ Correctional Facilities, ____ Government, ____ Industry, ____ infusion care, ____ managed care, ____ Nuclear Pharmacist, ____ Other) $25 for each additional academy added. How did you hear about us? (please choose from list below) ____ Pharmacists' Prof. Society of the San Fernando Valley member ____ PPSSFV.org website ____ web search ____ word of mouth Method of Payment: ____ Check made payable to CPhA for $___________ ____ Charge $___________ to my (check one): ___ VISA ___ Mastercard (Card Number ___________________________ Exp. Date ____ / ____) Signature ___________________________________________________ Note: CPhA dues are not deductible as a charitable contribution. Effective January 1, 2004, the IRS will not allow a deduction for the 40% of your CPhA dues spent for lobbying purposes. Consult your accountant for more information. Ten percent of your membership dues are used in publishing the California Pharmacist. Questions? call the Membership Division at (800) 444-3851 (CA Only) or (916) 779-1400   Questions? Send us an e-mail!   © 1999 - 2004 California Pharmacists Association
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