MPA Annual Membership Renewal

If you would like to renew your membership with Michigan Pharmacists Associaton, please fill out the form below and submit payment. If you are not sure which membership category to choose, please contact Penney Aiken at penney@michiganpharmacists.org or (517) 377-0222. Note: this is for renewals ONLY, if you are a new member, please go to: www.michiganpharmacists.org/join and register to become a new member.

First Name *

Middle Name *

Last Name *

Maiden Name (if applicable)

Spouse Name (if applicable)

Gender *

Date of Birth *

If you have a Canadian address, please call our office to renew

Home Street Address *

Address Line 2

City *

State *

Zip Code *

Employer Name (students enter university attending) *

Job Title

Work Street Address *

Address Line 2

City *

State *

Zip Code *

Cell Phone Number *

Work Phone Number *

Home Phone Number

CPE Monitor #

Educational Institute *

Date of Graduation *

Practice Section *

Primary Email Address *

Secondary Email Address

Membership Renewal Type (please choose from dropdown below) *

Current Total:

$0.00

Click CONTINUE to go to payment processing

Disclosure *

Due to technical difficulties, we are not able to offer auto-renewals at this time. Please note this is a single renewal payment and you will receive a statement prior to your next renewal date.