Northern Ohio Academy of Pharmacy Membership Form


Name


Spouse name


Home address

                                                                    

City


Zip code


Phone


Cell Phone


E-mail


Ohio Reg. No.


NABP No.


Pharmacy


Address


City


Zip code


Phone


College attended


Degree & date


Professional Organizations


I am applying for:


     
      Pharmacist membership ($75)


                Technician membership ($20)


                Pharmagram mailed to your home add $10


Make checks payable to Northern Ohio Academy of Pharmacy or NOAP

Mail to P.O. Box 771570, Lakewood, OH 44107


*   The Omnibus Budget Reconciliation Act of 1987 States:

Dues payments to the Northern Ohio Academy of Pharmacy are not deductible as charitable contributions for Federal Income Tax purposes. However, they may be deductible under other provisions of the Internal Revenue Code.

** Contributions to the Education Fund are fully tax-deductible as charitable contributions.