PANL Forms 2019-20
To Fourth Year Students registering as Pharmacists
Please note that once you receive your PEBC results, you will require to fill out the 2019-20 Pharmacist Membership Form(New Pharmacist). If you have purchased Student Liability Insurance through PANL, you will require to upgrade to Professional Liability Coverage, using the 2019-20 Student Liability Insurance Upgrade from Student/Intern to Pharmacist prior to July 1, 2020. If you have any questions or require further clarification, please contact the PANL office at firstname.lastname@example.org or 709-753-7881.
If you are registering as an Intern please complete the regular Pharmacist Membership stating 'Intern' in the license number section. Once completed you may avail of the Student/Intern Liability Insurance.
If you have any questions or require further clarification, please contact the PANL office at email@example.com or 709-753-7881.
Membership Application / Renewal
Please ensure you submit the correct form. A $15.00 processing fee will be charged for refunds.
2019-20 | Valid April 1, 2019-March 31, 2020