Recent Graduate Membership Application - 2018

This Membership Application is for Recent Graduates who received a certificate in their graduation packet OR for 2018 Residents who received certificate via email from the KSHP office.

If you have any questions regarding this application please contact the KSHP office at
awest@kshp.org.


I graduated during 2018 and received a KSHP complimentary membership certificate in my graduation packet. OR I began my Residency in 2018 and received an emailed certificate from the KSHP office.:
Yes
No
First Name::
Last Name::
Address 1::
Address 2::
City::
State::
Zip::
Office Phone::
Mobile Phone::
Fax Number::
Email::
Graduation Date (mm/dd/yy)::
Check all that apply::
RPh
PharmD
Are you interested in volunteering on a committee?:
Yes
No
Enter Code (found on the certificate you received in your graduation packet)::