2024 Fall Pharmacy Forum Registration
Saturday, November 9, 2024 | Center for Health Education & Research
Name
*
First Name
Last Name
Credentials
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Employer / Affiliation
*
County of practice:
*
Bath
Boyd
Carter
Clark
Elliott
Fleming
Greenup
Lawrence
Lewis
Mason
Menifee
Montgomery
Morgan
Nicholas
Powell
Robertson
Rowan
Other
If you chose other, please specify.
Specialty
*
PharmD
Pharmacy Technician
Student
Other
If you chose other, please specify.
What type of credit do you need?
ACPE-P (pharmacist)
ACPE-T (technician)
Certificate of Participation
None
How did you hear about this event?
Social Media
Via Email
Flyer
Through your employer
Through a friend
Submit
Should be Empty: