First Name:
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click "submit
application" to
mail in with
check payment.
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proceed to
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you click
Submit.
Last Name:
Address:
Zip:
City:
Telephone:
e-Mail:
RPh License PS:
CPh License PU:
Tech Registration  RPT:
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Select whether you are RENEWING or NEW member
Select your Membership Category
Note: submit application only once.  Clicking
more than once sends multiple applications.
Membership Dues:
Pharmacists          $60.00/yr
Technicians          $35.00/yr
Associate Memb   $35.00/yr
Pharm Student      free
For more information
contact DCPA at
dcpa@dcpa.us
Dade County Pharmacy Association
Membership Application Form
Payment Options:

1.  Mail this application with the appropriate dues to:

Dade County Phamacy Association
c/o C. Aceves-Blumenthal, Treas
1627 Brickell Ave #1104
Miami, FL 33129

2. Submit your application on line and mail payment to the above address.

3. Submit your application on line and use Paypal Secure
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