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First Name:
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Last Name:
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Address:
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City:
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State:
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State
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Washington,D.C.
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Division of Pharmacy Practice:
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Community - Independent
Community - Chain
Hospital - University/University-Affiliated
Hospital - Other
Home Health Care
Long-term Care
Mail Service Facility
Managed Health Care
Education/Vocational Training
Pharmaceutical Industry
Military
Academia
Other
How long have you been practicing in the pharmacy marketplace?
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Less than 6 months - 1 year
6 months - 1 year
2-3 years
4-5 years
6-10 years
11-20 years
More than 20 years
What is the name of your employer?
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Albertsons
CVS Pharmacy
Cardinal Health
Rite Aide
Walgreens
Longs
Medicine Shoppe
Neighbor Care
Safeway
Target
Wal-Mart
Advocate Hospital Group
Rush Hospital Group
University of Chicago
University of Illinois at Chicago
Other
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What is your current role in your practice setting?
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Pharmacy Technician
Pharmacy Manager
Pharmacy Student
Clinical Pharmacist in Health System setting
Staff pharmacist
Other
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What are your reasons for becoming an AIPhA member? (check all that apply)
For Continuing Education
For Culture activities
For Professional Support
To make my practice more professional
To make my practice more profitable
Curiosity for the organization
Would you be interested in any of AIPhA's rep representative committees?
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Pharmacy Technician
Independents
MTM-Medicare
Political Action and Legal Affairs
Student and Pharmacy Technician Group
Hospital and Chain Group
Please indicate your level of education in the pharmacy marketplace.
College of Pharmacy in the United States. Please list the name:
College of Pharmacy in India. Please list the name:
Pharmacy Technician School. Please list the name:
University or College. Please list the name:
What are your expectations from AIPhA in the next 10 years? (click all that apply)
To continue offering Continuing Education and organizing social functions
To become more politically active in the pharmacy marketplace
To lobby and network better with state and federal government employees
To remain an organization serving the needs of pharmacy stores.
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