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Member Registration
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Are you a pharmacist or pharmacy student of Eritrean origin?
Yes
No
First Name
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Middle Name
Last Name
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Title (Dr, Mr, Mrs, Ms)
Email Address
*
Location
Which University/College did you graduate from? (Include all institutions that you got your pharmacy/pharmacy related degree(s) from.)
Which year did you enroll?
What year did you graduate? (If you are still a student, when is your expected graduation year?)
In which sector do you currently work?
*
Community Pharmacy
Independent Pharmacy
Industry
Academia
Research
Hospital Pharmacy
A student
Other
If you answered "Other" above, what is your area of work.
Do you agree to abide by EriPCo's code of conduct and membership guidelines?
*
Yes
Are you able to pay an annual membership fee? – The annual membership fee is $100 or equivalent to $100 in your choice of currency. – For pharmacists who are in transition the annual membership fee is $50 or equivalent to $50 in your choice of currency. – Membership fee is waived for pharmacy students. – Individuals who can not pay the annual fee will be accommodated.
*
Yes
No
*** Please Note: After submitting this form, you will be forwarded to a page where you will create your own password for your account. Enter the same email you provided above and a password reset link will be sent to your email. With your new password, you can log into My Membership page and make the payment for your subscription level, if applicable.
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