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Annual Convention Registration

A key service to our membership is the planning and coordination of events designed to inform and educate Alaska's pharmacy professionals. These events often include Continuing Education classes, informative seminars and the chance to network with fellow professionals from around the state. You can register for our annual conference right here, on-line. After you submit your registration, an automated receipt will appear which you may print or save. If you provide an e-mail address, a registration summary will be promptly e-mailed as well.

  • Please note that no refunds will be given after January 15, 2017.
  • Prior to January 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 Skip to Technicians/Students
Select days you wish to attend (registration includes Saturday awards reception):
     Saturday – members: $135
     Sunday – members: $135

     Non-member + $225.

     Full conference price, $270 for members, $495 for non-members
        
Registrations received after January 15 and at the door will be charged a late registration fee of $50.
D. Technician/Student Registration
Select days you wish to attend (registration includes Saturday awards reception):
     Saturday – members: $85
     Sunday – members: $85

     Non-member + $50.

     Full conference price, $170 for members, $220 for non-members
        
Registrations received after January 15 and at the door will be charged a late registration fee of $50.
E. Membership Renewal – Membership year is January 1 - December 31
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 Academy of Heath-System Pharmacy Membership ~ must be an AKPhA member
    Pharmacist – $25
    Technician – $10

Committee Participation

Please indicate if you'd like to participate on one of our committees, or reconfirm your commitment to your current committee so we can keep our records updated. Thank you for your support and participation!

Awards

Community Relations

Legislative

Membership

Public Relations/Advertising

Scholarships/Silent Auction

Convention/Continuing Education

Academic/UAA

Technician Advocacy

Nominations/Board Development

AkPhA may occasionally photograph our events and may use your name and/or photographic representation 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. Membership Auto Renewal Option
    One-time only
    Auto Renew me each year
    Effective I authorize AkPHA to renew my annual membership and bill the credit card
    indicated below each year until I notify AkPHA otherwise. Membership will be renewed for Jan 1 - Dec 31.

Dues and contributions are not deductible as a charitable contribution for income tax purposes, but may be deductible as ordinary business expenses, subject to IRS restrictions. AkPhA estimates that 45% of your dues dollar is non-deductible because of AkPhA's lobbying activities on behalf of its members.

G. 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:

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