APhA Pharmacy-Based Immunization Delivery certificate training program Interest Form

In order to facilitate Ohio pharmacists' ability to broaden their scope of practice, OPA plans to offer the APHA Pharmacy-Based Immunization Delivery certificate training program. If you are interested, please complete the following secure form.* You will be contacted via the email provided on this form when the next program is scheduled.

Please use this form to update any incorrect fields below. Please use proper-case formatting as this information is what will appear in your record.

First Name Middle Last
Suffix
OH Pharmacist License #
Preferred Email
(Notices about upcoming Immunization Training programming will be sent via email.)

Home Address

Address
City State Zip
Home Phone Mobile
Please Check the APhA’s Pharmacy-Based Immunization Delivery certificate training program
Interest box below.
APhA Immunization Delivery Program Interest
Comments
 
Please note: current OPA members have preferred registration status for this and other programs with limited seating. Thank you for your interest!
Join now at www.ohiopharmacists.org/Join
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