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MAPS 2008 Application

Checks ($25)  should be made payable to MAPS.  
Mail your dues to our Treasurer: Yolanda Williams • PO Box 342953 • Memphis, TN • 38184
Or you can bring your application and dues to the next MAPS meeting.

Please indicate if you are:

p Pharmacist                                  

p Pharmacy RESIDENT-complimentary membership while a residen

p New Pharmacist graduating in 2008_Free Membership for 2008

Name_____________________________________________________________________

E-mail* (Clearly Please) ________________________________________________________

SECOND Email _______________________________________________________________

HomePh______________________Workplace______________________ Work Ph___________________

State License #____________________ or Last 4 digits of your SS#   ____________________

For MAPS use only:        

PAID      check/cash        Date: ________           MAPS

Optional Information

*Meeting Notices done by Email Unless you Have no Email Access; We appreciate your assistance in advance.

Address______________________________

City __________________________State__________ Zip____________________

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