Residency Showcase at Annual Convention 2024

1
Program Information* This field is required.If multiple sites, please only enter information for the first site here.
Program Title
Please Select
Please Select
PGY-1 Community Based Pharmacy Residency
Residency/Fellowship in Association Management
PGY-1/PGY-2 Combined Program
Fellowship or Unaccredited Residency
Other
Program Classification
Program City
Program State
Please Select
Please Select
Yes
No
Does this program have multiple sites/locations?
2
Site 2 Information
Title
Please Select
Please Select
PGY-1 Community Based Pharmacy Residency
Residency/Fellowship in Association Management
PGY-1/PGY-2 Combined Program
Fellowship or Unaccredited Residency
Other
Program Classification
City
State
Please Select
Please Select
Yes
No
Does this program offer any additional sites/locations?
3
Site 3 Information
Title
Please Select
Please Select
PGY-1 Community Based Pharmacy Residency
Residency/Fellowship in Association Management
PGY-1/PGY-2 Combined Program
Fellowship or Unaccredited Residency
Other
Program Classification
City
State
Please Select
Please Select
Yes
No
Does this program offer any additional sites/locations?
4
Site 4 Information
Title
Please Select
Please Select
PGY-1 Community Based Pharmacy Residency
Residency/Fellowship in Association Management
PGY-1/PGY-2 Combined Program
Fellowship or Unaccredited Residency
Other
Program Classification
City
State
Please Select
Please Select
Yes
No
Does this program offer any additional sites/locations?
5
Site 5 Information
Title
Please Select
Please Select
PGY-1 Community Based Pharmacy Residency
Residency/Fellowship in Association Management
PGY-1/PGY-2 Combined Program
Fellowship or Unaccredited Residency
Other
Program Classification
City
State
Please Select
Please Select
Yes
No
Does this program offer any additional sites/locations?
6
Website Link to Program Information (optional)
7
Point of Contact* This field is required.
First Name
Last Name
Email
Phone number
8
Program Director* This field is required.
First Name
Last Name
Email
9
Exhibitor 1 Information* This field is required.Will be on-site at the Annual Convention in Columbus, OH
First Name
Last Name
Position/Title
Email
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Please Select
Yes
No
Are there additional exhibitors?
10
Exhibitor 2 Information (optional)Will be on-site at the Annual Convention in Columbus, OH
First Name
Last Name
Position/Title
Email
Please Select
Please Select
Yes
No
Are there additional exhibitors?
11
Exhibitor 3 Information (optional)Will be on-site at the Annual Convention in Columbus, OH
First Name
Last Name
Position/Title
Email
Please Select
Please Select
Yes
No
Are there additional exhibitors?
12
Exhibitor 4 Information (optional)Will be on-site at the Annual Convention in Columbus, OH
First Name
Last Name
Position/Title
Email
13
Questions/Comments
14
Are you interested in participating in NCPA's Virtual Residency Showcase (Date TBD). Separate registration will be required.* This field is required.
YESNO
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