ACCP-SCCP 2017-2018 Membership

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Thank you for your interest in joining the American College of Clinical Pharmacy (ACCP) at UCSF! In order to become a member, please complete the following:

1) Fill out this form for local UCSF ACCP membership.
2) Submit your $15 local membership dues via Venmo (@ACCPUCSF) or cash via Treasurer, Kennedy (Kennedy.Ngotran@ucsf.edu).
3) Submit your $40 national student membership dues through (https://www.accp.com/membership/join.aspx)
4) Join the Northern California College of Clinical Pharmacy, NCCCP, for free with paid local and national ACCP membership! https://docs.google.com/forms/d/1dRM6Lf2-loDJkOmaA4vKuOtHcoyGThGXU0O6VEAQktc/viewform

We're excited for you to join us this year!
Sincerely,
ACCP-SCCP at UCSF Cabinet
accp@ucsf.edu

For any further questions please message:
Matthew Sugidono
ACCP-SCCP at UCSF President '17-'18
Matthew.Sugidono@ucsf.edu

First Name *

Last Name *

Date of Birth *

YYYY

UCSF Email Address *

Phone Number *

Year in School *

P1 (Class of 2021P)

P2 (Class of 2020)

P3 (Class of 2019)

P4 (Class of 2018)

Current Mailing Address *

City *

State *

Zip Code *

Have you paid your Local Membership Dues ($15)? *

Already paid via Venmo to ACCPUCSF

Will pay via Venmo (@ACCPUCSF)

Prefer to pay by cash by contacting Kennedy (Kennedy.Ngotran@ucsf.edu)

Have you paid your National Membership Dues ($40)? *

Already paid

Will pay via https://www.accp.com/membership/join.aspx

Have you joined NCCCP? *

Already joined (Must pay for both Local and National ACCP Membership)

Will join via https://docs.google.com/forms/d/e/1FAIpQLSfmNUhz0en5In9oph0mwSaBMbRDJI2LcxdPkBaxLxfaIhvHJg/viewform

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