OPA New Member Application

2015 Dues Year - Join NOW to take advantage of discounted member rates on OPA's upcoming programming!**

Please note: Pharmacists licensed between January 01, 2015 and
October 01, 2015 have received a complimentary membership valid through 01/31/2016.

Active Member - $260

Joint Member with Current Active Member Spouse - $135

First Year Pharmacist - (2015 Graduate or Resident PGY1) - $85

Second Year Pharmacist (2014 Graduate or Resident PGY2) - $150

Third Year Pharmacist (2013 Graduate) - $195

Retired Member (Must be 65 & retired from full-time practice.) - $100

Associate Members:

Primary Associate - $190

Additional Associate - $100

Additional Associates must provide the name of the Primary Associate member from your company below.

(non-pharmacist only - enter N/A in OH License #, College Attended, and Graduation Year fields to proceed.) -
New Member Name
OH Pharmacist License #
Preferred Mailing Address: Home Work
Home Address
Work Address
(This is the email address that will be used to contact you for all OPA email communications including legislative updates, programming information and other important OPA e-bulletins.)
Home Phone
Work Phone
College Attended
Graduation Year
R.Ph PharmD Other
Employment Type
Practice Setting

(*First Year Ohio pharmacists receive a complimentary OPA membership through January of the year following licensure.)

Membership Rate:

Primary Associate's Name:
(For Additional Associate's use only.)
How did you hear about OPA?

If you’d like to make a voluntary contribution to the Ohio Pharmacy PAC, OPA’s political action committee, please fill in the amount in the space provided below. (Personal contributions only.)
PAC Contribution
I affirm that my OPA Pharmacy PAC contribution has been made with non-corporate funds.

If you’d like to consider making a charitable contribution to the Ohio Pharmacists Foundation, please fill in the amount in the space provided below.
OPF Contribution
   - denotes required fields