PPAG -Pediatric Pharmacy Advocacy Group The Pediatric Pharmacy Advocacy Group
Make a Contribution - Donate to PPAG Today!


PPAG Member Login

User Name:
Password:
Remember Login:
 
Forgot your password?
 
Or, to request a login for this site, click here.
 
 


PPAG
7953 Stage Hills Blvd. Suite 101
Memphis, TN 38133
T: 901.380.3617
F: 901.266.4751

Facebook logo

Linkedin logo

PPAG on Twitter

GoodSearch cause banner

  
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: Personal Information
 First Name*  
 Initial  
 Last Name*  
 Company  
 Position Title  
 Sponsor or Recruiter
 
 Name of member who recruited you to join PPAG.

 
 
Section 2: Primary Contact Information
 E-mail*  
 Providing your e-mail address allows you to receive timely information. we do not sell or distribute e-mail addresses.

 
 Mailing Address*  
 Address 2*  
 City*  
 State*  
 Zip*  
 Country*  
 Address Type*  
 Work Phone*  
 Home Phone  
 Mobile Phone  
 Pager  
 Fax  
 Hide AddressYes    No
 
 Hide EmailYes    No
 
 Hide PhoneYes    No
 
 
Section 3: Additional Contact Information (optional)
 E-mail 2  
 Address  
 Address 2  
 City  
 State  
 Zip Code  
 Country  
 Address Type  
 
Section 4: Professional Practice Information
 Professional Degree(s) 
 Certifications*  
 Please list all certifications, seperated with a comma

 
 How long in practice?*     
 Licensed in State*  
 Areas of Expertise*
  Ambulatory Care
Cardiology
Critical Care
General Peds
Hematology/Oncology
Infectious Disease
Informatics
Intensive Care
Medication Safety
Neonatal Pharmacy
Nutrition/GI
Pediatric Formulation
Pharmacy Administration
Pulmonary
Teaching
Technology
Transplantation
Urology/Nephrology
Women's Health
 
 
Section 5: Subscribe to Groups
 Local Network  
 Please indicate if you are a member of one of our recognized local networks.

 
 Join a Committee
Advocacy Committee
Education Committee
Finance and Audit Committee
Fundraising Committee
Member Services Committee
Research Committee
 
 
Section 6: Payment
 Membership Type*
 $190.00 - 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.
$190.00 - 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.
$60.00 - Pharmacy Technician: Does not include receipt of the Journal of Pediatric Pharmacy Practice.
$60.00 - Resident/Fellow Member: Eligible only if he/she is a pharmacist in a residency or fellowship program. (Proof required)
$40.00 - Student: Eligible only if he/she is a student in an accredited school of pharmacy. (Proof required)
 
 Payment Method*
    Credit card
    Check
 
 

For security reasons,

type in the code below:

Play Sound