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Subscription form

* Mandatory fields
*First & Middle Name
*Nickname
What is your preferred first name?
*Last name
*Greeting
Credentials
ex. PharmD, PhD, MBA, PharmD Candidate, RPh, PhT, CPhT, RN, FASHP
*Organization
Employer or if you are a student, PharmD Program
*Position
Job title or if a student, PharmD candidate
Pharma
YES = All individuals who work for pharmaceutical companies
*Phone with area code
primary phone number
cell/other
*Texts
May we send you occasional text messages?
*Email
Email 2
secondary email address
*Home Address 1
Please provide a personal, local mailing address.
*Home City
*Home State
*Home Zip
We will use this address for mailings
Congress Dist
CSHP will add this once we know your local/CT home address.
Date Joined
Enter your date of application
Renewed
Paid Thru
CSHP will add this depending on your membership category and other information you provide.
Work Address
W City
W State/country
W Zip
W Area code
W Phone
Director
Clear selection
Select if applicable
Education
Student members must provide a graduation date. All others, provide your degrees, where you earned your degrees and when(optional)you earned your degrees.
Specialty
Describe your particular area of practice/medical specialty; for associates, what medical areas do your products address
Pharm license number
Provide your CT pharm license number
NABP #, month/day of birth
Provide NABP # AND Month/Day of birth to receive CE credit
ASHP membership
Volunteer Interest
Check Get Involved for options. Type in mentoring newer professionals; work on a specific committee, task force or initiative; assist with CTW or other conference; nominations; etc.
Ambassador
Spread the word about CSHP and our activities at your facility. Encourage people to join CSHP.

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About CSHP

Since 1948, the Connecticut Society of Health-System Pharmacists has represented the professional interests and provided professional development for CT pharmacists, educators and pharmacists in training.

Contacts

c/o The Association Advantage, LLC

591 North Avenue

Suite 3-2

Wakefield, MA 01880-1617

Phone - Toll-free: (888) 506-3784 (506-DRUG)


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