Pharmacy Connect - Panel Discussion for Pharmacy Professionals

To register for the upcoming panel discussion please enter your details as requested below. Once we receive your details we will send you a request for payment for the event.

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* 1. Personal Details

Firstname

Lastname

Personal e-mail address

Work e-mail address

Cell no (personal)

Cell no (work)

What city do you live in currently?

What province do you live in currently?

Current employer

Your position

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* 2. What type of pharmacy professional are you:

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* 3. Pharmacy Registration Information

South African Pharmacy Council (SAPC) P Number

Do not have a P Number (please provide a reason why you don't have a P Number)

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* 4. Prepayment is required to confirm your registration for the event.
I am able to pay the registration fee by:

EFT

Credit card

Bank deposit

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* 1. Personal Details

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* 2. What type of pharmacy professional are you:

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* 3. Pharmacy Registration Information

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* 4. Prepayment is required to confirm your registration for the event. I am able to pay the registration fee by:

* 4. Prepayment is required to confirm your registration for the event.
I am able to pay the registration fee by: