2019 Pharmacist of the Year Award

Deadline: May 3rd, 2019

Name of Nominator*
First Last
Email*
Telephone*
Address*
Address City Province Postal Code
Name of Pharmacist
First Last
Work Location
Please upload a letter or outline as to why the candidate should be awarded Pharmacists of the Year*
• Deadline for submissions is Friday, May 3, 2019

• All submissions are kept strictly confidential until award is presented on September 21, 2019
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