PLS Alumni Information
If you are a PLS member, please fill out this form so the alumni engagement committee can have your updated information to load into our new alumni database.

If you have questions, please reach out to me.

Thanks,
Anthony DeClue
atdeclue@gmail.com

Please list your FIRST name.
Your answer
Please list your LAST name.
Your answer
Please list your degree, credentials, and certifications, if applicable. Ex: PharmD, BCPS or BSPharm, PhD. If you are a student please say the year you graduate. Ex: Student (Class of 2019)
Your answer
Please list your e-mail (prefer non-school email, please list a "permanent" email).
Your answer
Please list your phone number.
Your answer
Are you willing to mentor a pharmacy student and/or new practitioner?
Please list the current organization where you work or where you attend pharmacy school if you are currently a student.
Your answer
Please list your current title (such as clinical pharmacy specialist, outpatient infusion center manager, assistant professor, student, PGY1 resident, PGY2 resident, fellow etc).
Your answer
Please list your areas of expertise if you are currently a practitioner (students can leave this blank).
Your answer
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