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* 1. First Name

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* 2. Last Name

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* 3. City

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* 4. Province

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* 5. Email Address

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* 6. Telephone Number

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* 7. Have you attended past PTSA Conferences?

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* 8. If yes, approximately how many times have you attended?

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* 9. Which best describes the area you practice in?

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* 10. What is something  you'd like your Indispensable Connection to know about you (related to Pharmacy)?

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* 11. What is something you'd like your Indispensable Connection to know about you (not related to Pharmacy)?

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* 12. Will you be available and in Edmonton the evening of September 12, 2019? (You do not have to be available to participate in the program)

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