Membership Application

NOTE : All parts of the application are required unless otherwise exempted.

Part 1 : Applicant information












Graduate of :

Year of Graduation :

Degree :

List all pharmacy organizations in which you are an active member :

Part 2 : Pharmacy information

Floor area : compounding area only :

Floor area : dispensing area,
including compounding area :

Total floor area of the pharmacy :

Part 3 : Web site information

Please indicate if you would like to have any of the following listed on the ACPC website at www.acpcrx.org

Pharmacy Web Site:

Pharmacy E-mail:

Specialized Services (Please check all that apply):


A - Autism
H - Hormones
Nm - Natural Medicine

Dt - Dentistry
I - Injectables
Hp - Homeopathy

De - Dermatology
P - Pain
N - Naturopathy

Pd - Pediatrics
G - General Compounding

O - Ophthalmology
V - Veterinary


Part 4 : Declaration by member/applicant

I affirm that the information contained in this application is true and accurate, to the best of my knowledge. I also consent to the ACPC verifying this information as necessary, including my being a member in good standing with my provincial licensing body(ies).

i) that I have read, understand and shall comply with the “Criteria for Membership in the ACPC” and will abide by those criteria at all times during my membership, as well as with all by-laws of the Association;

ii) that as a condition of membership in the ACPC, I acknowledge that I am not employed by or associated with a publicly traded company operating as a pharmacy, and should that occur, I must forfeit my membership forthwith in writing to the ACPC Board of Directors; and

iii) that should I fail to comply with any of the above criteria, it shall constitute grounds for revocation of my membership with no compensation therefore.



Part 5 : Create Your Account

You will use your email to login.

Password :


Part 6 : Membership