South Chapter November 2011 meeting

1.

Question Title

1. Will you be attending the CE dinner program "Hospital Based Immunizations" on Wednesday, November 30, 2011 at Kennedy Corporate Center

Yes

No

Question Title

2. Contact information

First name

Last name

City

State

Email address

Question Title

3. Are you a

Pharmacist

Technician

Other

Other (please specify)

Question Title

4. Membership status

Membership is active

Non-member or need to renew

Question Title

5. Do you need CE credits from this meeting?

Yes

No