Auburn Pharmacist Alumni Association
Membership Form
 

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To become a member:
1. Print out and complete this form.
2. Attach bank check payable to "APAA". OR Fill out Credit Card information.
3. Mail to Harrison School of Pharmacy, Auburn Pharmacist Alumni Association,  2316 Walker Building, Auburn University, AL 36849‑5501.
    OR fax to 334-844-8353.

Questions?  You may contact Jimmy Harris Alumni & Development Director at 844-8352.

*Please include all information requested.

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NAME :_______________________________________________________________
(Last........... First.......... Middle)

HOME PHONE: (____) _________-___________.
WORK PHONE: (____) _________-___________.

ADDRESS:
Street (w/APT. No.) or P. O. Box___________________________________________
City_______________________________________
State_____ ZIP_______________________ 

Email________________________________________
 

DUES:

  1st year graduate - Free!
  2nd and 3rd year graduates - $25/year
  4th through 30th year graduates - $50/year
  > 30 year graduates - $40/year
  Affiliates who did not attend HSOP - $60/year

  Married HSOP alumni - $10 discount per category
(e.g. married couple in their 3rd year of practice - $40/year)

METHOD OF PAYMENT:

Check  (make checks payable to "APAA")

Visa     MasterCard
Account Number:_____________________________________________________
Expiration Date: ________________________

SIGNATURE:___________________________________________
(must sign to pay by credit card)

revised August 07, 2009