Change of Contact Form

If you have moved, changed your phone number or email address, please complete the following form and submit to CSHP as soon as possible. CSHP sends out e-nnouncements regularly so it is important that we have your most current email address on file. It is also important to us that you don't miss your CSHP mailings, such as the eBulletin, and the Canadian Journal of Hospital Pharmacy (CJHP). Providing us with your most current information will prevent you from missing correspondence from CSHP.

This form will be sent automatically to Robyn Rockwell, National Membership Administrator, who will make the necessary changes upon the date requested. If you have any questions, please contact Robyn Rockwell by email or phone (613) 736.9733 ext 222.

Contact Information
Full Name:
CSHP Number:
Title/Position (current):
Name of Hospital /Faculty/ Company (current):
Previous contact information
Mailing address:
Email address:
Home Phone:
Work Phone:
Fax:
NEW contact information
Mailing address:
Email address:
Home Phone:
Work Phone:
Fax:
Effective Date of Change: (yyyy-mm-dd)
Comments: