2020-21 Pharmacy Student MembershipRenewal Deadline: March 31, 2021 CONTACT INFORMATIONStudent Membership is available to students currently enrolled in the MUN School of Pharmacy program.Student Name* First Last Middle Name or InitialMember's Address* Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Telephone*Email Address* I want to receive member updates, event notifications and other important information via my preferred contact email.* Yes No Important NoticePlease be advised that PANL uses email as the primary method of contacting members. You will not receive renewal notices and other important information. Privacy StatementYour privacy is important to us. PANL does not sell or otherwise provide your personal information to third parties not associated with the provision of PANL services, programs or publications. PANL uses appropriate safeguards to ensure that your personal information remains confidential. I the undersigned, certify that the information contained in this application is complete and correct and authorize PANL to collect, use and share the information contained in this application for the sole purposes set out in the privacy statement noted above. Student Signature*Date*Membership Payment | Online Payment Price: $ 50.00 CAD Student Membership Fee $50 + hst Please note that this form is used for Pharmacy Student Membership. If you have any questions, please contact PANL Office at 709-753-7881 prior to submitting. If there is an error in selecting the appropriate form and a refund is required, there will be a $15.00 administration fee applied automatically. Subtotal $ 0.00 CAD HST $ 0.00 CAD Total $ 0.00 CAD Credit Card* Card Details Cardholder Name To help us match your online payment with your registration form please tell us the legal name on the credit card account used for payment.**EmailThis field is for validation purposes and should be left unchanged. Telephone:(709) 753-7881Toll Free:(866) 753-7881Fax:(709) 753-8882Email:email@panl.netPANLMembership Benefits of Membership Volunteer – Board Nomination Process Board Member Benefits and Responsibilities Membership Applications & Forms
