To Join AlSHP: complete the membership application below and mail with check, if necessary, to:

Alabama Society of Health-System Pharmacists

P.O. Box 660662

Birmingham, AL 35266-0662

Current Members: enter your information below (for the membership directory):

(Dr., Mr., Ms...)
First Name:
MI:
Last Name:
Address:
City:
State:
Zip Code:
County of Residence
Legislative District
Place of Employment & City
Home Phone:
Business Phone:
Fax Number:
Email:
State(s) licensed to practice and license number(s)
Check membership status desired
	Active Member $75
	Associate Member $75
	Joint $125 (pharmacist couples with same mailing address)
	Resident $50
	Retired $50
	Technician $30
	Student $10
Type of License?
	Parenteral License
	Consultant License
Students Only:
School:
Present Academic Year:
Anticipated Mo/Yr of Graduation: