Employer-Based Pharmacy Technician Training Programs Order Form

Order Form for Employer-Based Pharmacy Technician Training Programs - to be ordered by pharmacists ONLY
Please allow up to 1-2 weeks for delivery of both programs via email to the supervising pharmacist. THESE PROGRAMS CANNOT BE RETURNED FOR A REFUND.
Entire Name
(First/Middle/Last)
Address
City/State/Zip
Company Name
Home Phone
Work Phone
Email
Please select the Employer-Based Pharmacy Technician Training Program you would like to purchase.
PassAssured’s Pharmacy Technician Training Program
Name of Pass Assured Registered User/Technician(First/Middle/Last)
Email address of Registered User/Technician
Name of supervising pharmacist
Email address of supervising pharmacist
OPA's Employer-Based Pharmacy Technician Training Program
   - denotes required fields