Membership Application

1Personal Data:

First Name

Last Name

Address

City

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Phone

Email Address (Required)

 

2Certified

ExCPT

PTCB

Not Certified

Other

 

3Professional Data:

Workplace Name Position/Title Work Email

 

4Preferred Email:

Email is required for AAPT Member communications

Home

Work

5Type Of Practice SETTING (Select one):

Community/Retail

Academia

Hospital Inpatient

Long-term Care

Mail Order

Hospital Outpatient

Military

Non-practicing Student

Nuclear

Home Infusion

Oncology

PBM/Insurance

Retired

Sterile Compounding

Other

 

6Interested in Working on a Committee:

Communications

Continuing Education

Legal & Public Affairs

Organizational Affairs

Convention

 

7Type of Membership:

Active (full membership): $50.00

Associate (Pharmacist or other Interested Professional): $75.00

1st Year in the Field (1 yr membership for those new to the career): $25.00

Pharmacy Technician Student*: $15.00

Retired (previously active member): $17.00

 

8College or Training Program

*NOTE to Students: Please include name of school and instructor email so we can verify your status.

Instructor email

 

Before completing your application, please read the statement below and check the "I Agree" box below.

I Agree My annual membership dues help the association provide many services and projects to advance our pharmacy technician profession goals. AAPT strives to offer a variety (typically 4/year) of free on-line pharmacy technician-specific continuing education topics to members. Most CPE is offered at annual convention(typically 10-15CPE). Because I’m a member, my convention fee & online CPE topics are discounted. Refund Policy: Individuals are able to cancel application & receive a refund less a 25% processing fee when cancelling within 3-business days after making application and payment. Cancellation after membership benefits have been utilized or outside of the 3-day policy will not be refunded. A written request for cancellation must be made to aapt@pharmacytechnician.com

 

9Online Payment Information:

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Password (Required)

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