Alumni Initiate Application

Name
First Last
Submission Date
Date Format: MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*
Education
Please upload a copy of your pharmacy diploma or pharmacist license
College/University
Degree
Date of Graduation
File
College/University
Degree
Date of Graduation
File
College/University
Degree
Date of Graduation
File
States Licensed in
Professional Experience
You may attach a current resume if available
What are your goals and objectives in joining Lambda Kappa Sigma?
Sponsoring Member/Chapter Name
When and where initiation will take place
Signature of Applicant
Date
Date Format: MM slash DD slash YYYY
This application will be reviewed by Grand Council at their next monthly meeting. Applicants will then be contacted by HQ staff with instructions on how to make their first dues payment in the member portal ($75), and to set up their initiation date.

Education