NINTH ANNUAL
MARYLAND PHARMACY
LEGISLATIVE DAY
FEBRUARY 18, 2010
SPONSORED BY
MARYLAND PHARMACY COALITION

REGISTRATION

Use the online form below to sign up to participate in the 10th Annual Maryland Pharmacy Legislative Day in Annapolis on February 18, 2010. Please submit this form by February 1st, 2010.

Submitted By (Firstname Lastname): Required
Your Email Address: Required
Home Address:
City: , State: , Zip:
Home Phone:

Business Phone:
Name of Employer/School:
Business Street Address:
City: , State: , Zip:


Home Legislative District:
Business Legislative District:

Legislative Districts can be found by acccessing the website of the State Legislature at http://mlis.state.md.us or http://mdelect.net


Check All That Apply: MD-ASCP, MPhA, MPhS, MSHP, MPhA,
UMB Student, ND Student, UMES Student,
UMB Faculty, ND Faculty, UMES Faculty,
Owner, Employee

COMMENTS:

IF YOU CANNOT ATTEND LEGISLATIVE DAY FOR ANY REASON AFTER REGISTERING, PLEASE CALL HOWARD SCHIFF AT (410) 727-0746. THANK YOU AND WE LOOK FORWARD TO SEEING YOU IN ANNAPOLIS.

8480-M Baltimore National Pike, #252 - Ellicott City, MD 21043 - 410.465.9975 - email: mshp@rxassociationmgt.com