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WSPA                           ANNUAL MEETING
Great Wolf Lodge, Grand Mound, WA	 					
                                                              November 2-4, 2012
                                                              Register at www.wsparx.org




                                   Anything But Ordinary...

                                    J
                                        oin us at the Great Wolf Lodge in Grand Mound, WA for the
                                        WSPA’s 2012 Annual Meeting, November 2-4, 2012!

                                    This year’s meeting will offer a unique blend of professional
                                    development and family entertainment. From the moment
                                    you enter the soaring Great Wolf Lodge lobby and find yourself
                                    surrounded in the north woods theme, you will know that this
                                    meeting will be anything but ordinary.

                                    This is an “Everything Under One Roof” destination. You can park
                                    your car and never need it again until it is time to go home.

                                    Join us with your family on Friday, November 2nd for the annual
                                    WSPA Awards of Distinction Banquet. We will also be introducing
                                    the new 2012-2013 WSPA Board of Directors members and
                                    honoring Washington State’s 50 Year Pharmacists.

                                    On Saturday, we will kick off our CE sessions in an adjacent
                                    conference center located away from the hub of activity. In your
                                    absence, the adults in your group will enjoy spacious guest
                                    rooms, amazing restaurants, a luxurious spa, fitness center and
                                    world-class entertainment while the children can be engaged in
                                    everything from waterslides and Story Time to huge arcades to
                                    MagiQuest - there are activities in every direction.
Enjoy an Affordable Stay!

         We were able to negotiate an incredible deal! Family Suites are available at the WSPA Annual Meeting rate of
         $149/night and includes access to the water park for November 2-4, 2012 if reserved by October 5th. Please
         refer to code “1210WAST” when making your reservations. To reserve your room, please call 800-640-WOLF
         (9653). For more information about the hotel visit their website at www.greatwolf.com.




                                          Fun for the WHOLE Family!
T
     hroughout the entire Grand Mound, WA lodge, you’ll find a range of activities that will keep children and adults active and entertained for hours. There
     are also a variety of area attractions that you may want to check out! Visit www.greatwolflodge.com for more information. Otherwise, check out these
     great in-house attractions!

Dining - there is plenty to choose from in this one stop shop. Whether you want a snack or sit down dinner, the Great Wolf Lodge has it all. Choose from The
Loose Moose Cottage, Camp Critter Bar & Grille, Grizzly Rob’s Bar, Bear Paw Sweets & Eats, Pizza Hut Express, Spirit Island™ Snack Shop, Starbucks® Coffee, and
Hungry as a Wolf.

Fitness - Start the day off with a great workout in the Iron Horse Fitness Center. It’s open 24 hours!

Spa - Elements Spa Salon at the Great Wolf Lodge offers guests the perfect retreat. Elements Spa is a mini
getaway designed for you to slow down and unwind in our serene yet energizing space. Choose from a
menu of services from a deep relaxation massage to a rejuvenating facial. WSPA Annual Meeting attendees
get a 15% discount!

There’s also Scooops Kid Spa - a special spa created for celebrating everything from birthdays to those occa-
sional “just because” treats in life. Let us spoil your fingers and toes with flavored manicures and pedicures.

Shopping - No trip is complete without shopping! There are several shops within the lodge that are great
for kids and adults alike including the Buckhorn Exchange™, Great Wolf Stuffing Station™, MagiQuest®
Wand Shop, and the Bear Essentials™ Swim Shop and Crocs Store Galore. Want to get some great deals? The
Centralia Factory Outlets are only 15 minutes away!

MagiQuest® - With a magic wand in-hand, you’ll explore an enchanted kingdom and join in the ultimate
adventure as you enchant objects, befriend a pixie, learn from an ancient wizard, battle a goblin and outwit
a dragon. We guarantee this live-action adventure game is unlike any other you’ve ever played. You’re sure to
become legendary when the getaway you planned becomes epic.

gr8_space™ - We’ve solved the age-old question of how to entertain teenagers. gr8_Space is teenage nirvana:
A hang-out that’s tricked-out with teen-appropriate computer internet access, mp3 docking stations, and mul-
tiple gaming systems including PlayStation® 3*, Xbox 360®** and Nintendo Wii™***. gr8_Space is supervised
by a “Tech Jockey” who spins the latest tunes, and host nightly special events like Rock Star Karaoke

Cub Club® - We’ve packed this kid haven with activities and crafts designed to enlighten and entertain your
younger ones for hours. Plus, the hands-on programming, crafts, activities and custom souvenirs will give
those cute, pruney little hands a break from the water park fun.

Northern Lights™ Arcade - If kids designed your family room, it would probably look something like this. The
bright lights of our sprawling, family-friendly arcade is packed with a variety of games designed to bring out
the inner child in everyone.

Compass Quest™ - Find your way to a new adventure! Prepare to unlock a whole new layer of MagiQuest!
A hi-tech compass leads you on an interactive wayfinding adventure unveiling nine new quests in this next
generation game of magic, mystery and discovery!

Water Park - Great Wolf Lodge in Grand Mound, WA is your one-stop-shop for family fun and entertainment.
With rides and slides for parents and kids of all ages, there’s something for everyone to enjoy at our indoor
Continuing Education:
   You Can Count on High-Quality, Relevant Sessions

   E                                                                        Annual Meeting Schedule
         ducation is the very core of the 2012 Annual Meeting. The
         CE programming is directed to pharmacists, technicians, and
         students practicing in various healthcare settings including
   chain drug stores, clinics, hospitals, independently owned               Friday
   community pharmacies, industry, long-term care, and managed              6:30 - 9:00 pm        WSPA Awards of Distinction Banquet
   care.

   Conference Objectives                                                    Saturday
   The conference will provide continuing pharmacy education for            7:15 - 8:00 am    	   Coffee/Pastries
   the profession of pharmacy in a structured educational activity
                                                                            8 :00 am - 12:50 pm   Continuing Education Activities
   designed or intended to support the continuing development
   of pharmacists, pharmacy technicians and pharmacy students               12:50 - 2:00 pm       Lunch
   to maintain and enhance their competence. The continuing                 1:00 - 2:00 pm		      Technician & Student Forum 1 hr CE
   education activities will promote problem-solving and critical           2:00 - 7:00 pm        Continuing Education Activities
   thinking and be applicable to the practice of pharmacy.
                                                                            3:30 - 7:30 pm        Exhibit Hall and Reception
   About Continuing Education Programs
   In order to ensure timely and pertinent continuing education             Sunday
   content, we develop our CE in relatively close proximity to the
   event. For up-to-date information on the ACPE accredited CE              7:15- 8 am            Coffee/Pastries
   activities including target audience, activity descriptions, learning    8:00 - 11:10pm        Continuing Education Activities
   objectives, and faculty please go to www.wsparx.org.
                                                                            11:10 - 1:20pm        Lunch/General Membership Meeting (No CE)
                                                                            1:20 - 4:30 pm        Continuing Education Activities
   To Earn CE Credit
   Check in for the conference, complete a meeting evaluation and
   the statement of credit. Keep track of your credits by writing
   the activity codes during each activity you attend. At the end
   of the conference have your statement of credit validated
   by a Convention Staff member following completion of all
   activities you have attended. The yellow copy will be your official
   Continuing Pharmacy Education Statement of Credit.



                 The Washington State Pharmacy Association is accredited
                 by the Accreditation Council for Pharmacy Education as a
                 Provider of continuing pharmacy education




Exhibit Hall:
Meet Suppliers


W
            ith more
            than 25
            exhibits,
you will find a
comprehensive
display of the latest
innovative products
and services available
today for pharmacy
practice. Talk with experts and see the latest in everything essential to
pharmacy. The Exhibit Hall will be open Saturday from 3:30 - 7:30 pm and
includes a social reception.
2012 WSPA Annual Meeting
c/o Washington State Pharmacy Association
411 Williams Avenue South
Renton, WA 98057




                 U s!
 Jo in                             ANNUAL MEETING
             Great Wolf Lodge| November 2-4, 2012 | Grand Mound, WA
2012 WSPA Annual Meeting Registration Form
Great Wolf Lodge hotel rooms are available. The Great Wolf Lodge is located at 20500 Old Highway 99, SW, Centralia, WA,
98531. Rates are $149/night for Nov. 2-4 if reserved by Oct. 5. Please call 1-800-640-9653 for reservations and ask for the
Washington State Pharmacy Association meeting rate and group code 1210WAST.

 Registration Information
Please type or print clearly.

Name:
                                                                                                                            Annual Meeting  Nov. 2-4, 2012
Nick Name for Badge:                                             Birthday:
                                                                                              Month / Day                           Great Wolf Lodge
Home Address:
                                                                                                                                    Grand Mound, WA
City, State, Zip:                                                   Phone:
NAPB e-Profile #:                              Go to http://www.nabp.net/ to obtain your NAPB e- profile number.
                                               It will be required for all 2013 CE.

*Email:
                                                                    *Required for confirmation and pre-meeting materials.


Meeting Fees
Please circle the appropriate dollar amount.                                               Get Early Bird Pricing Until October 5th!
Early Bird if received by Oct. 5th | Regular Rate 10/6-10/21
Add $100 after 10/21                                                                [ ] I would like to include my 2013 membership fee.
                                                                                         (See back page for details and pricing)
Full Registration:
Includes served meals both days; Friday Awards Dinner;                              If renewing or becoming a member, please fill out the form on the back of this
Saturday Exhibit Hall & Happy Hour; and ACPE accredited CE for                      page.
both days.
                                    Member                Nonmember
          Pharmacist                $265 / $315           $460 / $510               Please fill out the following information so that we may get an
          Fellow/Resident PGY 1-3   $170 / $220           $255 / $305               accurate count for the Awards Of Distinction Dinner.
          Technician                $170 / $220           $220 / $270
          Student                   $170 / $220           $190 / $230               Will you be attending the Friday, Nov. 2nd Awards Dinner (6:30 -
                                                                                    9:00 pm)?
Saturday, Nov. 3 Registration:                                                      [ ] Yes [ ] No
Includes served meals; Exhibit Hall & Happy Hour; and ACPE
accredited CE for one day.
                                                                                    Additional Awards Dinner Tickets
                                    Member                Nonmember
          Pharmacist                $195 / $245            $ 390 / $440             Adult Plate: ______ x $60 = $_______
          Fellow/Resident PGY 1-3   $155 / $205            $ 240 / $290
                                                                                    Child’s Plate? _______ x $15 = $_________
          Technician                $ 95 / $145           $145 / $195
          Student                   $ 95 / $145           $ 115 / $165              Do you or your guests have a dietary preference? Please indicate
                                                                                    below.
Sunday, Nov. 4 Registration:
Includes served meals and ACPE accredited CE for one day.                           [ ] Gluten Free
                                    Member               Nonmember                  Please indicate how many people with this preference ___
          Pharmacist                $175 / $ 225         $370 / $420
          Fellow/Resident PGY 1-3   $ 95 / $145          $180 / $230
                                                                                    [ ] Vegetarian
          Technician                $ 95 / $145          $145 / $195                Please indicate how many people with this preference ___
          Student                   $ 95 / $145          $115 / $165

Method of Payment                                                                    How to Register
After October 21st, add $100                                                       1. Online at www.wsparx.org
                                                                                   2. Call WSPA at 425-228-7171.
                                                                                   3. Fax completed form to WSPA at 425-277-3897.
                                                                                   4. Mail completed form to WSPA, 411 Williams Ave. South, Renton,
Grand Total: $ ______ (Registration, Membership, Awards Banquet Tickets)
                                                                                   WA 98057.
[ ] Check to WSPA
Charge to [ ] MasterCard            [ ] Visa         [ ] Discover                    Cancellation Policy
                                                                                   If cancellation is received by Oct. 29 a refund will be made minus a $30 processing fee. No
Card #: __________________________________________                                 refunds will be issued after Oct. 29. WSPA reserves the right to cancel any seminar due to insuf-
                                                                                   ficient registration or severe weather; registrants will be notified and receive a full refund.
Expiration Date:_____________3 Digit Security Code:__________

Signature: _____________________________________________
You can now renew online!
                                                                                                                       Visit www.wsparx.org and click the
                                                                                                                               “Membership” tab!
                                                           Annual Membership Form
Please complete the information below.
CONTACT/PROFILE INFORMATION                                                                  NEW PAYMENT OPTIONS
Name:_____________________________________________________                                                      Monthly Payments
Address:                                                                                 You can now break down your membership into monthly
____________________________________________________________                                     payments! Simply check the box under
                                                             City | State | Zip               “membership dues” when filling out this form!
Preferred Phone:____________________________________________                                         *You can opt out of monthly payments after 1 year.

Preferred Email:_____________________________________________
License Number: ______________ NAPB e-Profile#______________                                                 Annual Auto-Renewal
Go to http://www.nabp.net/ to obtain your NAPD number. This will be                  Benefits:
a requirement to get your CE for 2013.
                                                                                     • Never have to worry about renewal dates again
Date of Birth: _______-_______-_______                                               • Uninterrupted access to member-only website content
                                                                                     • Convenience of pre-planning your membership budget
University and Year of Graduation:                                                   • Opt out at any time
____________________________________________________________
                                                                                      Check here if you wish NOT to auto-renew your
Practice Academy (choose all that apply):                                              membership
 Community/Ambulatory Care  Long-Term Care
 Health Systems                 Students
 Independent Pharmacy           Technicians

  A. MEMBERSHIP DUES                                                                  B. LOCAL CHAPTERS
 Pharmacist with LRAC Membership.........................$270                      Spokane Pharmacy Association
   I prefer monthly installments of $23.99/month                                    Practicing Pharmacist, Pharmacy Rep (RPh or non RPh)
                                                                                       other Health Professionals and Industry Reps .......$50
 Pharmacist.................................................................$195
                                                                                     Pharmacy Technician or Retired Pharmacist ........$25
   I prefer monthly installments of $17.99/month
                                                                                     Pharmacy Student....................................................$10
                                                                                                                                                       Total B: $ ____
 Associate Pharmacist
  (out of state|non-practicing) ................................$135
   I prefer monthly installments of $12.99/month                                     C. VOLUNTARY CONTRIBUTIONS
                                                                                     Legislative and Regulatory Affairs Council (LRAC)
 Associate Non-Pharmacist .....................................$135                  Individual Pharmacist Membership - $75
   I prefer monthly installments of $12.99/month                                      Technician or Student - $15
 Pharmacy Professional Student in WA State ........$20                              Washington State Pharmacy Foundation (student scholarships)
                                                                                                                                 Donation Amount: $______________
 Graduate Pharmacist First Full Year ........................$95                    (*Contributions to WSPF are optional. Contributions to the Washington State Pharmacy
   I prefer monthly installments of $8.99/month                                    Foundation (WSPF) are tax deductible as a charitable contribution. Contributions to
                                                                                    WSPA or LRAC are not deductible as charitable contributions. However, WSPA dues may
 Pharmacy Practice Resident/Fellow ......................$85                       be deductible as an ordinary and necessary business expense. A portion of your dues
   I prefer monthly installments of $7.99/month                                    (approximately $30.00) includes a subscription to the official publications of the Washing-
                                                                                    ton State Pharmacy Association, Non-deductible portion of

 Retired Pharmacist (Over 65 yrs old) ......................$75
                                                                                    WSPA dues: 15% (attributable to Lobbying Expense.)                 Total C: $     ____
   I prefer monthly installments of $6.99/month                                      PAYMENT
                                                                                    Payment may be made by check payable to WSPA or
 Pharmacy Technician ..............................................$50
                                                                                    Authorization to charge Amount Due to my credit card:
   I prefer monthly installments of $4.99/month
                                                                                                                                 Check here if you wish NOT to
 Spouse / Partner Pharmacist ..................................$340                Total: A+B+C=__________                     auto-renew your membership.
   I prefer monthly installments of $29.99/month
                                                                                     Visa      MasterCard  Discover
*You can opt out of monthly payments
            after 1 year.
                                                     Total A: $ ____                Card Number:______________________________________________
                                                                                    Expiration Date: _____________3 Digit Security Code_____________
                                     Return this form with your payment to: Washington State Pharmacy Association,
                                            411 Williams Avenue S, Renton, WA 98057 or fax to: (425)277-3897
            411 Williams Avenue S | Renton, Washington | 98057 | Phone: 425.228.7171 | Fax: 425.277.3897 | www.wsparx.org

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Event Promo Material - Annual Meeting

  • 1. WSPA ANNUAL MEETING Great Wolf Lodge, Grand Mound, WA November 2-4, 2012 Register at www.wsparx.org Anything But Ordinary... J oin us at the Great Wolf Lodge in Grand Mound, WA for the WSPA’s 2012 Annual Meeting, November 2-4, 2012! This year’s meeting will offer a unique blend of professional development and family entertainment. From the moment you enter the soaring Great Wolf Lodge lobby and find yourself surrounded in the north woods theme, you will know that this meeting will be anything but ordinary. This is an “Everything Under One Roof” destination. You can park your car and never need it again until it is time to go home. Join us with your family on Friday, November 2nd for the annual WSPA Awards of Distinction Banquet. We will also be introducing the new 2012-2013 WSPA Board of Directors members and honoring Washington State’s 50 Year Pharmacists. On Saturday, we will kick off our CE sessions in an adjacent conference center located away from the hub of activity. In your absence, the adults in your group will enjoy spacious guest rooms, amazing restaurants, a luxurious spa, fitness center and world-class entertainment while the children can be engaged in everything from waterslides and Story Time to huge arcades to MagiQuest - there are activities in every direction.
  • 2. Enjoy an Affordable Stay! We were able to negotiate an incredible deal! Family Suites are available at the WSPA Annual Meeting rate of $149/night and includes access to the water park for November 2-4, 2012 if reserved by October 5th. Please refer to code “1210WAST” when making your reservations. To reserve your room, please call 800-640-WOLF (9653). For more information about the hotel visit their website at www.greatwolf.com. Fun for the WHOLE Family! T hroughout the entire Grand Mound, WA lodge, you’ll find a range of activities that will keep children and adults active and entertained for hours. There are also a variety of area attractions that you may want to check out! Visit www.greatwolflodge.com for more information. Otherwise, check out these great in-house attractions! Dining - there is plenty to choose from in this one stop shop. Whether you want a snack or sit down dinner, the Great Wolf Lodge has it all. Choose from The Loose Moose Cottage, Camp Critter Bar & Grille, Grizzly Rob’s Bar, Bear Paw Sweets & Eats, Pizza Hut Express, Spirit Island™ Snack Shop, Starbucks® Coffee, and Hungry as a Wolf. Fitness - Start the day off with a great workout in the Iron Horse Fitness Center. It’s open 24 hours! Spa - Elements Spa Salon at the Great Wolf Lodge offers guests the perfect retreat. Elements Spa is a mini getaway designed for you to slow down and unwind in our serene yet energizing space. Choose from a menu of services from a deep relaxation massage to a rejuvenating facial. WSPA Annual Meeting attendees get a 15% discount! There’s also Scooops Kid Spa - a special spa created for celebrating everything from birthdays to those occa- sional “just because” treats in life. Let us spoil your fingers and toes with flavored manicures and pedicures. Shopping - No trip is complete without shopping! There are several shops within the lodge that are great for kids and adults alike including the Buckhorn Exchange™, Great Wolf Stuffing Station™, MagiQuest® Wand Shop, and the Bear Essentials™ Swim Shop and Crocs Store Galore. Want to get some great deals? The Centralia Factory Outlets are only 15 minutes away! MagiQuest® - With a magic wand in-hand, you’ll explore an enchanted kingdom and join in the ultimate adventure as you enchant objects, befriend a pixie, learn from an ancient wizard, battle a goblin and outwit a dragon. We guarantee this live-action adventure game is unlike any other you’ve ever played. You’re sure to become legendary when the getaway you planned becomes epic. gr8_space™ - We’ve solved the age-old question of how to entertain teenagers. gr8_Space is teenage nirvana: A hang-out that’s tricked-out with teen-appropriate computer internet access, mp3 docking stations, and mul- tiple gaming systems including PlayStation® 3*, Xbox 360®** and Nintendo Wii™***. gr8_Space is supervised by a “Tech Jockey” who spins the latest tunes, and host nightly special events like Rock Star Karaoke Cub Club® - We’ve packed this kid haven with activities and crafts designed to enlighten and entertain your younger ones for hours. Plus, the hands-on programming, crafts, activities and custom souvenirs will give those cute, pruney little hands a break from the water park fun. Northern Lights™ Arcade - If kids designed your family room, it would probably look something like this. The bright lights of our sprawling, family-friendly arcade is packed with a variety of games designed to bring out the inner child in everyone. Compass Quest™ - Find your way to a new adventure! Prepare to unlock a whole new layer of MagiQuest! A hi-tech compass leads you on an interactive wayfinding adventure unveiling nine new quests in this next generation game of magic, mystery and discovery! Water Park - Great Wolf Lodge in Grand Mound, WA is your one-stop-shop for family fun and entertainment. With rides and slides for parents and kids of all ages, there’s something for everyone to enjoy at our indoor
  • 3. Continuing Education: You Can Count on High-Quality, Relevant Sessions E Annual Meeting Schedule ducation is the very core of the 2012 Annual Meeting. The CE programming is directed to pharmacists, technicians, and students practicing in various healthcare settings including chain drug stores, clinics, hospitals, independently owned Friday community pharmacies, industry, long-term care, and managed 6:30 - 9:00 pm WSPA Awards of Distinction Banquet care. Conference Objectives Saturday The conference will provide continuing pharmacy education for 7:15 - 8:00 am Coffee/Pastries the profession of pharmacy in a structured educational activity 8 :00 am - 12:50 pm Continuing Education Activities designed or intended to support the continuing development of pharmacists, pharmacy technicians and pharmacy students 12:50 - 2:00 pm Lunch to maintain and enhance their competence. The continuing 1:00 - 2:00 pm Technician & Student Forum 1 hr CE education activities will promote problem-solving and critical 2:00 - 7:00 pm Continuing Education Activities thinking and be applicable to the practice of pharmacy. 3:30 - 7:30 pm Exhibit Hall and Reception About Continuing Education Programs In order to ensure timely and pertinent continuing education Sunday content, we develop our CE in relatively close proximity to the event. For up-to-date information on the ACPE accredited CE 7:15- 8 am Coffee/Pastries activities including target audience, activity descriptions, learning 8:00 - 11:10pm Continuing Education Activities objectives, and faculty please go to www.wsparx.org. 11:10 - 1:20pm Lunch/General Membership Meeting (No CE) 1:20 - 4:30 pm Continuing Education Activities To Earn CE Credit Check in for the conference, complete a meeting evaluation and the statement of credit. Keep track of your credits by writing the activity codes during each activity you attend. At the end of the conference have your statement of credit validated by a Convention Staff member following completion of all activities you have attended. The yellow copy will be your official Continuing Pharmacy Education Statement of Credit. The Washington State Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a Provider of continuing pharmacy education Exhibit Hall: Meet Suppliers W ith more than 25 exhibits, you will find a comprehensive display of the latest innovative products and services available today for pharmacy practice. Talk with experts and see the latest in everything essential to pharmacy. The Exhibit Hall will be open Saturday from 3:30 - 7:30 pm and includes a social reception.
  • 4. 2012 WSPA Annual Meeting c/o Washington State Pharmacy Association 411 Williams Avenue South Renton, WA 98057 U s! Jo in ANNUAL MEETING Great Wolf Lodge| November 2-4, 2012 | Grand Mound, WA
  • 5. 2012 WSPA Annual Meeting Registration Form Great Wolf Lodge hotel rooms are available. The Great Wolf Lodge is located at 20500 Old Highway 99, SW, Centralia, WA, 98531. Rates are $149/night for Nov. 2-4 if reserved by Oct. 5. Please call 1-800-640-9653 for reservations and ask for the Washington State Pharmacy Association meeting rate and group code 1210WAST. Registration Information Please type or print clearly. Name: Annual Meeting  Nov. 2-4, 2012 Nick Name for Badge: Birthday: Month / Day Great Wolf Lodge Home Address: Grand Mound, WA City, State, Zip: Phone: NAPB e-Profile #: Go to http://www.nabp.net/ to obtain your NAPB e- profile number. It will be required for all 2013 CE. *Email: *Required for confirmation and pre-meeting materials. Meeting Fees Please circle the appropriate dollar amount. Get Early Bird Pricing Until October 5th! Early Bird if received by Oct. 5th | Regular Rate 10/6-10/21 Add $100 after 10/21 [ ] I would like to include my 2013 membership fee. (See back page for details and pricing) Full Registration: Includes served meals both days; Friday Awards Dinner; If renewing or becoming a member, please fill out the form on the back of this Saturday Exhibit Hall & Happy Hour; and ACPE accredited CE for page. both days. Member Nonmember Pharmacist $265 / $315 $460 / $510 Please fill out the following information so that we may get an Fellow/Resident PGY 1-3 $170 / $220 $255 / $305 accurate count for the Awards Of Distinction Dinner. Technician $170 / $220 $220 / $270 Student $170 / $220 $190 / $230 Will you be attending the Friday, Nov. 2nd Awards Dinner (6:30 - 9:00 pm)? Saturday, Nov. 3 Registration: [ ] Yes [ ] No Includes served meals; Exhibit Hall & Happy Hour; and ACPE accredited CE for one day. Additional Awards Dinner Tickets Member Nonmember Pharmacist $195 / $245 $ 390 / $440 Adult Plate: ______ x $60 = $_______ Fellow/Resident PGY 1-3 $155 / $205 $ 240 / $290 Child’s Plate? _______ x $15 = $_________ Technician $ 95 / $145 $145 / $195 Student $ 95 / $145 $ 115 / $165 Do you or your guests have a dietary preference? Please indicate below. Sunday, Nov. 4 Registration: Includes served meals and ACPE accredited CE for one day. [ ] Gluten Free Member Nonmember Please indicate how many people with this preference ___ Pharmacist $175 / $ 225 $370 / $420 Fellow/Resident PGY 1-3 $ 95 / $145 $180 / $230 [ ] Vegetarian Technician $ 95 / $145 $145 / $195 Please indicate how many people with this preference ___ Student $ 95 / $145 $115 / $165 Method of Payment How to Register After October 21st, add $100 1. Online at www.wsparx.org 2. Call WSPA at 425-228-7171. 3. Fax completed form to WSPA at 425-277-3897. 4. Mail completed form to WSPA, 411 Williams Ave. South, Renton, Grand Total: $ ______ (Registration, Membership, Awards Banquet Tickets) WA 98057. [ ] Check to WSPA Charge to [ ] MasterCard [ ] Visa [ ] Discover Cancellation Policy If cancellation is received by Oct. 29 a refund will be made minus a $30 processing fee. No Card #: __________________________________________ refunds will be issued after Oct. 29. WSPA reserves the right to cancel any seminar due to insuf- ficient registration or severe weather; registrants will be notified and receive a full refund. Expiration Date:_____________3 Digit Security Code:__________ Signature: _____________________________________________
  • 6. You can now renew online! Visit www.wsparx.org and click the “Membership” tab! Annual Membership Form Please complete the information below. CONTACT/PROFILE INFORMATION NEW PAYMENT OPTIONS Name:_____________________________________________________ Monthly Payments Address: You can now break down your membership into monthly ____________________________________________________________ payments! Simply check the box under City | State | Zip “membership dues” when filling out this form! Preferred Phone:____________________________________________ *You can opt out of monthly payments after 1 year. Preferred Email:_____________________________________________ License Number: ______________ NAPB e-Profile#______________ Annual Auto-Renewal Go to http://www.nabp.net/ to obtain your NAPD number. This will be Benefits: a requirement to get your CE for 2013. • Never have to worry about renewal dates again Date of Birth: _______-_______-_______ • Uninterrupted access to member-only website content • Convenience of pre-planning your membership budget University and Year of Graduation: • Opt out at any time ____________________________________________________________  Check here if you wish NOT to auto-renew your Practice Academy (choose all that apply): membership  Community/Ambulatory Care  Long-Term Care  Health Systems  Students  Independent Pharmacy  Technicians A. MEMBERSHIP DUES B. LOCAL CHAPTERS  Pharmacist with LRAC Membership.........................$270 Spokane Pharmacy Association  I prefer monthly installments of $23.99/month  Practicing Pharmacist, Pharmacy Rep (RPh or non RPh) other Health Professionals and Industry Reps .......$50  Pharmacist.................................................................$195  Pharmacy Technician or Retired Pharmacist ........$25  I prefer monthly installments of $17.99/month  Pharmacy Student....................................................$10 Total B: $ ____  Associate Pharmacist (out of state|non-practicing) ................................$135  I prefer monthly installments of $12.99/month C. VOLUNTARY CONTRIBUTIONS  Legislative and Regulatory Affairs Council (LRAC)  Associate Non-Pharmacist .....................................$135 Individual Pharmacist Membership - $75  I prefer monthly installments of $12.99/month Technician or Student - $15  Pharmacy Professional Student in WA State ........$20  Washington State Pharmacy Foundation (student scholarships) Donation Amount: $______________  Graduate Pharmacist First Full Year ........................$95 (*Contributions to WSPF are optional. Contributions to the Washington State Pharmacy  I prefer monthly installments of $8.99/month Foundation (WSPF) are tax deductible as a charitable contribution. Contributions to WSPA or LRAC are not deductible as charitable contributions. However, WSPA dues may  Pharmacy Practice Resident/Fellow ......................$85 be deductible as an ordinary and necessary business expense. A portion of your dues  I prefer monthly installments of $7.99/month (approximately $30.00) includes a subscription to the official publications of the Washing- ton State Pharmacy Association, Non-deductible portion of  Retired Pharmacist (Over 65 yrs old) ......................$75 WSPA dues: 15% (attributable to Lobbying Expense.) Total C: $ ____  I prefer monthly installments of $6.99/month PAYMENT Payment may be made by check payable to WSPA or  Pharmacy Technician ..............................................$50 Authorization to charge Amount Due to my credit card:  I prefer monthly installments of $4.99/month  Check here if you wish NOT to  Spouse / Partner Pharmacist ..................................$340 Total: A+B+C=__________ auto-renew your membership.  I prefer monthly installments of $29.99/month  Visa  MasterCard  Discover *You can opt out of monthly payments after 1 year. Total A: $ ____ Card Number:______________________________________________ Expiration Date: _____________3 Digit Security Code_____________ Return this form with your payment to: Washington State Pharmacy Association, 411 Williams Avenue S, Renton, WA 98057 or fax to: (425)277-3897 411 Williams Avenue S | Renton, Washington | 98057 | Phone: 425.228.7171 | Fax: 425.277.3897 | www.wsparx.org