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Note: The fees listed are for pre-registration. On-site registrants (space available) will be assessed an additional $25.00 fee. A detailed brochure will be mailed six weeks prior to the first program (to those on our regular mailing list) which will contain program schedule, travel instructions and registration form. If you are not on our regular mailing list, call, write or email and we will send you the brochure. Payment is accepted by check or money order (made out to AMS Pharmacy CE) or Amex, Visa, Mastercard or Discover - and mailed to address shown below. Credit card registration is accepted by fax or phone until 11am on the Friday before each program. Registrations must include social security number. Credit card numbers and expiration dates must be written out.
---------------------------------------Please cut and mail this form to register or change or add to our mailing list --------------------------------------
Department of Continuing Professional Education
Arnold & Marie Schwartz College of Pharmacy and Health Sciences
Long Island University, 75 DeKalb Avenue, Brooklyn, NY 11201-5497
Telephone 718-488-1065; Fax 718-780-4055; Email pharmce@brooklyn.liu.edu; LIU website www.liu.edu /pharmce |
| Name & SS#: |
| Address: |
( ) Check
here if this is a new address. (Please indicate
old address.) |
| City: |
State: |
Zip: |
( ) Check
here if you are not on our regular mailing list
and would like to be. |
| Daytime
Phone Number: |
( ) Check
here to be removed from our mailing list. |
| Contact Preference: ( ) U.S. mail ( ) E-mail: |
Payment is accepted by check or money order (made out to AMS Pharmacy CE) or Amex, Visa, Mastercard or Discover - and mailed to above address. Credit card registration is accepted by mail, fax or phone. Registrations must include social security number.
Seminar Title and Date________________________________________________________Amount_______________________
Credit Card #________________________________________________________________Exp date______________________
Signature of Cardholder_________________________________________________________________________
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The Arnold & Marie Schwartz College of Pharmacy and Health Sciences is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education." Statements of continuing pharmacy education credit will be mailed within six weeks of each program |
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