Medicare Prescription Drug Program
Powerpoint Presentation Request

Name 
Mailing Address
City
State   Zip
Phone
Email address
Format in which you would prefer your copy of the presentation

Payment Information
$10 per disk (shipping and handling included)
Copyright reserved by APA 11/26/2003
 

I would like to be billed to the address above.

I would like to pay for the materials by credit card
Credit Card Information:
Visa
MasterCard
Discover
American Express
Expiration Date


For additional information or question you may have, please contact Dr. Mark Riley (mriley@arpharmacists.org) or Mandy Childress (mchildress@arpharmacists.org) at the APA office at 501-372-5250.

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