Palm Beach County Pharmacy Association

Name:
E-mail:
Address:
City:
State:
Zip:
Home Phone#:
Cell Phone#:
Florida License Number: mandatory

Please check:	Registered Pharmacist Registered Technician

I would like to assist in serving our association members by getting involved
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Registered Pharmacist Membership (includes CE Broker)		$70

Registered Technician Membership (includes CE Broker)		$25

Non Member Session (Excludes CE Broker)		$20

Florida Licensed RHP Over 50 Years (Includes CE Broker)		$10

Contribution to Scholarship Fund for PBC 4th, 5th and 6th year Pharmacy Students

Please enter total amount due in box to the right