2021 Pharmacist of the Year Award

Deadline: Thursday, August 31, 2021

Name of Nominator*
First Last
Email*
Telephone*
Address*
Address City Province Postal Code
Nomination
Are you nominating an individual Pharmacist or a team?*
- Individual
- Team
Name of Pharmacy
Pharmacy Location
List Team Members
Name of Pharmacist
First Last
Work Location
Please upload a letter or outline as to why the candidate(s) should be awarded Pharmacist(s) of the Year
• Deadline for submissions is Thursday, August 31, 2021

• All submissions are kept strictly confidential until award is presented.
Drop files here or
Signature
Phone
This field is for validation purposes and should be left unchanged.

Telephone:

(709) 753-7881

Toll Free:

(866) 753-7881

Fax:

(709) 753-8882

Email:

email@panl.net

Nomination