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* 1. What is your first and last name?

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* 2. What is your mailing address?

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* 3. What is your email address?

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* 4. What is your phone number?

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* 5. What is your age?

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* 6. How long have you been a pharmacy technician?

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* 7. In which pharmacy setting are you currently practicing?

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* 8. Are you a certified pharmacy technician? If Yes, please specify year of certification

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* 9. If you are certified, from whom did you receive your certification?

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* 10. Other demographic information may be collected during monthly survey reporting.  Please make the study supervisor aware of any changes to your demographics such as job change or address change.

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