DCPA - Dues Demographic Form
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Email *
Last Name *
First Name *
Street Address *
City and ZIP *
Telephone *
Provide your FL Board of Pharmacy License Number(s):  PS, PU or RPT.  Please use the leading letters.  Ex:  RPT12345 *
Are you a member of the statewide "Florida Pharmacy Association?"
Annual Dues Payment Amount: includes representation of Pharmacy Practice to the State and National Associations, as well as visibility in legislative issues; free continuing education programs of 4 hours or less provided throughout the year.  Annual Dues are active until December of the year.   
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Payment Options *
THANK YOU FOR YOUR SUPPORT
A copy of your responses will be emailed to the address you provided.
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