NY State Chapter - ACCP

Join Us 

Clinical Pharmacists and other professionals are invited to join us in membership in the New York State Chapter of the American College of Clinical Pharmacy. To apply, or to renew your membership:

Please make your payment using the PayPal button and submit the membership request form at the bottom of this page. YOU MUST DO BOTH. Please specify your specialty/practice area in the field for "ADDRESS LINE 2".

If you are a student you must specify "STUDENT" in the "ADDRESS LINE 2" area and put the name of your college into the "COMPANY / ORGANIZATION NAME" field.

PayPal Section: Annual Membership Dues: $30. When your payment has been received and your membership request is approved (or renewed), you will receive acknowledgement in the form of a welcoming email containing your login ID and an initial password.

Membership Request Form
Please fill in this form and click the Penguin button.
(* = required field)
Prefix: (Mr, Ms, Mrs, Dr, Capt, etc.)
First name: *
Middle name or initial:
Last name: *
Suffix: (MD, RN, PhD, DDS, etc.)
Company or Organization name:
Home Address: *
Address line 2:
City: *
State: *
Zip/Postal Code: *
Phone 1:
Phone 2:
Phone 3:
Phone 4:
E-Mail Address: *
Click the PENGUIN to submit form


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