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PO BOX 683148 | Houston, TX 77268 | ph 888-247-8700 | fx 888-247-8706

NPTA is the largest professional society for pharmacy technicians. Membership is open to pharmacy technicians, students, and educators. more...

NPTA Membership Application

Download this application to pay by check Members Application
 
Section 1: Membership Informaion
User Name*
  
Password*
confirm password 		 
First Name*
  
Last Name*
  
Initials
  
Position Title*
  
Mailing Address*
  
Address Line 2
  
City*
  
State*
  
Zip Code*
  
Country
  
Phone
  
Home Phone
  
Pager/Mobile Phone
  
Fax
  
E-mail*
  
Are you nationally certified?   
  Yes
No
 
Gender   
  Female
Male
 
Date of Birth
  
Referred By NPTA Member: Member Name   
 
Referred By NPTA Member: Member ID#   
 
OR Referred by:    
  Today's Technician
NPTA Website
Internet
 
Referral Source Other   
 
 
Section 2: Membership Categories
What is your Primary Practice setting?   
  Retail - Chain
Retail - Grocery
Retail - Independent
Community Hospital
University Hospital
Government Hospital
Mail Over
Home Care
Long Term Care
Nuclear
Military
Correctional Facility
Formal Education
Sales
Other
 
How long have you been practicing in pharmacy?*   
  < 1 year
1-3 years
3-5 years
5-10 years
10-15 years
15-25 years
 
 
Section 3: Payment
Promotion Code
  
 
Section 4: Membership Type
All payments must be drawn on a US bank in US DOLLARS only. For Discounted Multi-Year Membership Rates, please call 888-247-8700.*   
 $187.00 - Membership Dues (3 Years) - Save $20
$128.00 - Membership Dues (2 Years) - Save $10
$94.00 - Membership Dues (1 Year) - International Rate (Outside of U.S.A.) $69+$25
$69.00 - Membership Dues (1 Year)
 
 
Section 5: Payment
Payment Method*
    Credit card
 
 
Section 6: Education History: ie CPhT, PT, BS, etc
Enter your Education History
School: Degree:
Major: Year Graduated:
       
School: Degree:
Major: Year Graduated:
       
School: Degree:
Major: Year Graduated:
       
School: Degree:
Major: Year Graduated:
       
 

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