To have your application pre-filled, please login before registering

AKPhA Academy of Health-System Pharmacy Conference Registration

October 8, 2016 ~ Hotel Alyeska

You must be a member of AKPhA and the AKPhA Academy of Health-System Pharmacy to attend (fees can be paid below--please note new Academy membership fee). AKPhA memberships are valid January 1 - December 31st.


Special Offer
– New AKPhA memberships and/or Academy dues received in conjunction with the conference will be valid for the remainder of 2016 and all of 2017.


After you submit your registration, an automated receipt will appear which you may print and save.  If you provide an email address, a registration summary will be promptly emailed to you as well.

  • Please note that no refunds will be given after September 15th
  • Prior to September 15th, 50% of fees may be refunded upon request
Personal Information
First Name
Last Name
E-mail Address
Address
City
State, ZIP
Home Phone
Work Phone
AK Driver's License#
Update Login
NABP e-profile id#
Date of Birth
Please list any food allergies or dietary needs:
B. Professional Information
Business Name/Employer
Business Mailing Address
State, ZIP
Business City
Fax Number
 
C. Pharmacist Registration
Saturday – members: $145 + $25 AK Academy Dues
     Registrations received after September 15 and at the door will be charged a late registration fee of $25.
D. Technician/Student Registration
Saturday – members: $85 + $10 AK Academy Dues
     Registrations received after September 15 and at the door will be charged a late registration fee of $25.
E. Become a Member – New AKPhA Memberships and/or Academy dues received in conjunction with this conference will be valid for the remainder of 2016 and all of 2017
Pharmacy/Corporation Membership:
    Corporate Membership – $1,500
    Business Membership – $300
Individual Membership
    Pharmacist Membership – $225
    Pharmacist 1st year graduate membership – $125
    Associate (non-pharmacist) – $150
    Technician Membership – $50
    Pharmacy Student – $25
AKPhA may occasionally photograph our events and may use your name and/or photographic representation of you in the promotion of our programs. Please check this box if you DO NOT authorize this use:
     Do Not use my name or photograph
F. Donation Opportunities
    $ Scholarship Donation – Allows the Association to encourage careers in pharmacy.
    $ Legislative Fund – Allows the Association to provide an effective advocacy voice in Juneau
    $ General Donation – Supports the Association in general operations and growth
H. Payment Information
Credit Card Number

Or type "Bill Me" if you prefer
Credit Card Expiration
 /    CVV:
CVV is a 3 digit number on back of your card
Credit Card Type
Please type the word at right:

Not readable? Change text.
 


Privacy Statement: Alaska Pharmacists Association will not disclose your personal information to third parties without your written consent.