2016-17 OPA Membership Application - Member Get a Member Program

Thank you for choosing to join OPA online through our Member Get a Member program. Please be sure to indicate below, the name of the OPA member who referred you to OPA. Welcome to OPA! We appreciate your support!
**Please note: Pharmacists licensed between October 01, 2015 and
October 01, 2016 receive a complimentary membership valid through 01/31/2017.

Member Types

Active Member - $260
Joint Member with Paid Current Active Member Spouse - $135
First Year Pharmacist (2016 Graduate or Resident PGY2) - $85
Second Year Pharmacist (2015 Graduate or Resident PGY2) - $150
Third Year Pharmacist (2014 Graduate) - $195
Retired Member (Must be 65 & retired from full-time practice.) - $100

Associate Members

Primary Associate - $190
Additional Associate - $110
Additional Associates must provide the name of the Primary Associate member from your company below.
(Non-Pharmacist ONLY - enter N/A in OH License #, College Attended, and Graduation Year fields to proceed.) -

Contact Information

Please use this OPA membership application to update any incorrect fields below. Please use proper-case formatting as this information is what will appear in your record.

First Middle Last
Suffix
OH Pharmacist License #
Preferred Email
(This is the email address that will be used to contact you for all OPA email communications including legislative updates, programming information and other important OPA e-bulletins.)

Work Address

Note: If you do not have a company address, please leave the following company-related fields blank.

,
Company Name
Address
City State Zip
Work Phone Fax
Toll-Free

Home Address

Address
City State Zip
Home Phone Mobile

Primary Address

Please indicate ONE Primary address to which you wish to receive all OPA mailings.
Primary Address WORK Address is Primary Address
HOME Address is Primary Address

Additional Information

College Attended
Graduation Year
R.Ph PharmD Other
Employment Type
Practice Setting

(*First Year Ohio pharmacists receive a complimentary OPA membership through January of the year following licensure.)

Membership Rate

Please choose Membership Level

Referred to OPA by:

Continuing Education

12 Home Study CPE quizzes published in 2016 ($30.00) (Doesn't include Jursiprudence)
One Jurisprudence Published in 2016 ($10.00)

NEW! Automatic Annual Renewal

Check here if you are paying by credit card and wish to sign up for Automatic Annual Renewal. Your dues and any amount your choose to donate to the Pharmacy PAC, OPF, or to your continuing education, that you indicate on this form, will be automatically charged to your credit card annually each year in your month of renewal. Questions? Please contact us at opa@ohiopharmacists.org or 614-389-3236.

Optional Support

PAC Contribution

If you’d like to make a voluntary contribution to the Ohio Pharmacy PAC, OPA’s political action committee, please fill in the amount in the space provided below. (Personal contributions only.)
PAC Contribution Amount$
I affirm that my OPA Pharmacy PAC contribution has been made with non-corporate funds.

OPF Contribution

If you’d like to consider making a charitable contribution to the Ohio Pharmacists Foundation, please fill in the amount in the space provided below.
OPF Contribution Amount$

Note: Membership dues may constitute an ordinary and necessary business expense, but are not a charitable deduction. A portion of dues, however, is not deductible as an ordinary and necessary business expense to the extent that OPA engages in state or federal lobbying. The non-deductible portion of dues - the portion which is allocated to lobbying - for the current dues year is 18%.
   - denotes required fields