Immunization Training Interest Form

In order to facilitate Ohio pharmacists' ability to broaden their scope of practice, OPA plans to continue to offer this valuable program. If you would be interested in attending a Pharmacist Training Program for Immunizations program, please complete the following secure form.* This information will be used to contact you when the next program is scheduled.
*Please Note: The August 12 program was most likely the last immunization training we will offer in 2015.
Name
(First/Middle/Last)
Address
City
State
Zip
Primary Email Address
(Notices about upcoming Immunization Training programming will be sent via email.)
Please Select Program Interest.
I am interested in attending a future Immunization program.
Comments
 
Please note: current OPA members have preferred registration status for this and other programs with limited seating. Thank you for your interest!
   - denotes required fields