VtSHP Membership

To become a member, please fill out the electronic form below.
Or, if you prefer, you can also download the Membership Application
and follow the submisson instructions on the form.

Someone will be in contact with you promptly once your application has been submitted.

Vermont Society of Health-System Pharmacists
Membership Application / Renewal Form

Javascript must be enabled to submit your payment electronically.
Please enable Javascript and refresh this page.

Please visit this link to learn how to enable Javascript in your browser.

APPLICATION FOR NEW MEMBERS AND RENEWALS

Membership from April 1, 2011 to March 31, 2012


Name:
Address:
City, State, Zip:
Phone (Home):
Phone (Work):
E-mail:	(We would like to e-mail notices of upcoming events and news)
Employer:
Are you an ASHP member? Yes No
Please Check all that apply: Pharmacist - $40 Pharmacy Student, Resident, Fellow - $15 Technician - $15 Associate Member - $35 (non-pharmacy related)
(You will be redirected to PayPal to submit your Membership fee.)

If you have any questions, please contact Lisa Jackman (Email: lisa.jackman@vtmednet.org)

Please wait while we direct you to PayPal so that you may submit your payment...
(Membership Registration will not be completed until payment is submitted).

If you are not redirected within a few seconds, please Click Here to continue.

It appears Javascript is not enabled in your browser,
and we are unable to forward you to PayPal for payment.

Please utilize the following mail-in form to submit your payment:
Membership Application

VtSHP Membership

Vermont Society of Health-System Pharmacists Membership Application / Renewal Form

Vermont Society of Health-System Pharmacists
Membership Application / Renewal Form