2017 OPA Membership Application

ONLINE SPECIAL!! Join NOW to take advantage of discounted member rates on OPA's upcoming programming! Your membership will be valid through December 31, 2017.

Please note: Newly graduated pharmacists, licensed by exam from October 01, 2015 through September 30, 2016, have received 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.) -

Basic 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

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 have received a complimentary OPA membership through January of the year following licensure.)

Membership Rate

Please choose Membership Level
Primary Associate's Name (For Additional Associate's use only.)
Continuing Education
12 Home Study CPE quizzes published in 2017 ($30.00) (Doesn't include Jursiprudence)
One Jurisprudence Published in 2017 ($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.
Please share how you heard about OPA membership. If a current OPA member encouraged you to join, please be sure to include their name so they receive credit as an OPA Recruiting All Star. Thanks!

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$
   - denotes required fields