Hospital Pharmacy
FREE Subscription Application and Renewal Form
A complimentary subscription to the print edition of Hospital Pharmacy will be sent to applicants
who qualify. All questions must be answered completely. The Publisher reserves the right to limit the number of free subscriptions.
All fields highlighted in yellow are required to receive a FREE subscription.
If you are a current subscriber and wish to automatically fill in this form, you may
access your account data in the Account Lookup section below.
Account Lookup
Enter your Account Number
Enter the First 3 Letters of your Last Name
Look me Up!
How do I find my account Number?
Sample Label
Please enter all 7 digits of your customer identification number which can be found on your magazine's mailing label directly above your name. >>>>>>
 ********** 3 DIG 200
01 HPPA1234567
MR JOHN SMITH
1101 CONNECTICUT AVE NW
WASHINGTON, DC 20036

OR
If you are a new subscriber, you may enter your information below.
Keycode:  
Name and Address Information:
COMPANY ADDRESS:
First:
Middle:
Last:
Title:
Company:
Address1:
Address2:
City
State:   Zip:  
Country: USA
Telephone:
Fax:
Email:
Please confirm email address by rekeying below:
Email Rekey:
By supplying us with your email address, you will receive subscription notifications via email.
Demographic Information:
I would like to receive/continue to receive Hospital Pharmacy FREE of charge:
        Yes   No
1.) Which of the following best describes your title? (Check only one):
01 Director of Pharmacy
02 Asst. Director of Pharmacy
03 Supervisor/Manager of Pharmacy
04 Administrator of Pharmacy
05 Coordinator, Clinical Services
06 Clinical Pharmacist
07 Drug Information Pharmacist
09 Staff Pharmacist, Full Time
10 Staff Pharmacist, Part Time
11 Pharmacy Intern
12 Dean, Pharmacy School
13 Faculty, Pharmacy School
15 Pharmacy Technician Supervisor
16 Consultant Pharmacist
17 Materials Purchasing Manager
18 Vice President/President Organization/Faculty
99 Other (Please Specify):
2.) Business/Industry Type/Size of your Hospital/Institution/Organization? (Check only one):
01 Hospital 99 or less beds
02 Hospital 100 - 199 beds
03 Hospital 200 - 299 beds
04 Hospital 300 - 399 beds
05 Hospital 400 - 499 beds
06 Hospital 500+ beds
07 Nursing Home or Senior Care Facility
08 School of Pharmacy
09 HMO/Managed Care Organization
10 Clinic
11 Government Agency
12 Multi-Hospital
13 Consulting Company
14 Home Health Care Pharmacy
15 Pharmacy Benefit Management
16 Home Infusion
99 Other (Please Specify):
3.) Are you a member of your P & T Committee?
        Yes   No
4.) Are you on a subcommittee or an advisor on a committee influential in drug decision-making or formulary issues?
        Yes   No
Without the availability of a signature, our circulation auditing bureau requires that we ask you a personal identifier question in order to verify your request for this publication. This information is used solely for that verification purpose:
 
What is your eye color?
   

Publisher reserves the right to serve only those who meet demographic requirements.