Corporate Registration

Membership Level

Corporate Member - $1000 (USD)

XL Organizational Member - $499 (USD)

Institution or Organization Member Lg - $299 (USD)

Small Program Member - $199 (USD)

Individual Member - $65 (USD)

Student Member - $40 (USD)

Setup Username and Password

Email*

Please enter email address

Password*

Retype Password*

Password must be at least 6 characters long

Contact Details

Institution/Organization*

Upload Institution/Organization logo*

Institution/Organization website*

Institution/Organization Description*

Business Address

Country*

Address Line 1*

Address Line 2

Address Line 3

City*

State / Province / Region*

Zipcode*

Phone*

Mobile

Business Email

Facebook

Twitter

Primary Contact *

Email*

First Name*

Last Name*

Mobile Number*

Billing Contact (Optional)

First Name

Last Name

Mobile Number

Information to be included in Member Directory

Include my information in the Member Directory

Business Address

Business Phone Number

Work Email Address

College Information

Pharm. College/School

Grad Year

Employer Information

Employer*

Title

I understand by becoming a member of IAMR I am granting permission to IAMR to send emails to the contact email associated with my membership*

Membership Level

Setup Username and Password

Contact Details

Business Address

Primary Contact *

Billing Contact (Optional)

Associate Members (optional)

Information to be included in Member Directory

Administrative Assistant Details

College Information

Employer Information

Membership Level

Setup Username and Password

Contact Details

Business Address

Primary Contact *

Billing Contact (Optional)

Associate Members (optional)

Information to be included in Member Directory

Administrative Assistant Details

College Information

Employer Information

Select Profile Type