Committee Volunteer Form - The Kentucky Society of Health-System Pharmacists

Committee Volunteer Form

Complete the Volunteer Committee Form to sign up for a committee.

Please note: You MUST be a KSHP member in order to serve on a committee.

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This field is for validation purposes and should be left unchanged.
I am a current member of KSHP:*
- Yes
- No
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Organization (Current Employer or School [if student])
Email
Committee that is your FIRST choice:
Committee that is your SECOND choice:
Committee that is your THIRD choice:
Category of Membership:
- Pharmacist
- Resident
- Technician
- Pharmacy Student
- Technician Student
Buddy/Referred By (if someone referred you to the committee sign-up form)

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