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You DO NOT need a Pay Pal account to use this form.

Renewals
If you are renewing your membership, please check "renewal" and your district affiliation in the appropriate membership area.


New Members
Thanks for joining OSHP, we're sure you will enjoy and benefit from your membership.
Please select "new" and your district affiliation in the appropriate membership area. In addition, please fill out the on-line form below and submit it to our secretary for our database.


Change of Information
If your information has changed, please select "change" in the appropriate membership area along with the on-line form below.


Active - Pharmacist ($75.00)
Membership: District:


1st Year Pharmacist Licensee ($50.00)
Membership: District:


Associate - Supporting ($50.00)
Membership: District:


Associate - Technician ($20.00)
Membership: District:


Associate - Student ($10.00)
Membership: District:

If your are a new member or your information has changed,
please fill out this form and submit it.
THANKS for your support!

Please check if any of your information has changed.

Name (Last, First, MI)
Address
Address2
City, State, Zip
Home Phone
Work Phone
E-Mail
Confirm E-Mail
Employer
Title/Position
Date of birth
Sex
OK License #
District Affiliation*
College of Pharmacy Attended/Attending
Yr. Graduated or
Expected Graduation
Last Degree
Preferred Mailing
Membership Type
Active Pharmacist $75
Active First Year Pharmacist $50
Associate Supporting $50
Associate Technician $20
Associate Student $10
*OKC Area District Meeting = Western;
 Tulsa Area District Meeting = Eastern.


(Membership is based on the calendar year.
Dues paid after 10/1 extends membership through the end of the following calendar year.)

You should receive a receipt via e-mail shortly.
If you do not, please contact Ms. Lisa Slaton..

O.S.H.P.
P. O. Box 2371
Oklahoma City, OK 73101-2371

Updated: 5-6-2013