PPAG -Pediatric Pharmacy Advocacy Group The Pediatric Pharmacy Advocacy Group
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PPAG
7975 Stage Hills Blvd Ste 6
Memphis, TN 38133
T: 901.380.3617
F: 901.266.4751

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Pharmacists improving medication therapy in children


PPAG Membership Application

To join, fill out the fields below, or download application to pay by check:  Membership Application
 
Section 1: Practice Information
 First Name*  
 Initial  
 Last Name*  
 Company  
 Position Title  
 Mailing Address*  
 City*  
 State*  
 Zip*  
 Country  
 Work Phone  
 Home Phone  
 Mobile Phone  
 Pager  
 Fax  
 E-mail*  
 Providing your e-mail address allows you to receive timely information from PPAG . It is a PPAG policy to not sell or distribute e-mail addresses of members.

 
 Referral Source Member Name
 
 Hide AddressYes    No
 
 Hide EmailYes    No
 
 Hide PhoneYes    No
 
 Professional Degree(s) 
 Institution 
 Certifications*
 
 
 Areas of Expertise*
 
 
 How long in practice?*     
 Licensed in State*  
 
Section 2: Additional Addresses
 Same as Primary Address    
 Address  
 Address 2  
 City  
 State  
 Zip Code  
 Country  
 Address Type  
 
Section 3: Subscribe to Groups
 Subscribe to groups
Administrative SIG
Advocacy Committee
Advocacy SIG
Ambulatory Care SIG
Cardiology SIG
Critical Care SIG
Education Committee
Finance
Fundraising Committee
Hematology/Oncology SIG
Infectious Diseases SIG
Informatics, Technology, and Safety SIG
Membership Services Committee
Neonatology SIG
newsletter subscription (registration)
Nutrition SIG
Peds Formulation SIG
Pulmonary SIG
Research Committee
Solid Organ Transplate SIG
Urology/Nephrology SIG
Women's Health (OB/GYN) SIG
 
 
Section 4: Payment
 Membership Type*
 $150.00 - Associate Member: Eligible only if he/she is a non-pharmacist committed to the goals of this organization or a pharmacist not actively involved in institutional pharmacy practice.
$150.00 - Individual Member: Eligible only if he/she is a pharmacist committed to the goals of this organization and is actively involved in or has substantial experience in pediatric pharmacy practice.
$55.00 - Resident/Fellow Member: Eligible only if he/she is a pharmacist in a residency or fellowship program. (Proof required)
$35.00 - Pharmacy Technician: Does not include receipt of the Journal of Pediatric Pharmacy Practice.
$35.00 - Student: Eligible only if he/she is a student in an accredited school of pharmacy. (Proof required)
 
 Payment Method*
    Credit card
    Check
 
 
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