Wednesday February 8, 2012
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Take advantage of this unique opportunity to participate in a shared learning environment and find expert solutions

3 easy ways to register!

MAIL:
International Pharmaceutical Academy
420 Highway# 7 East, Box 82022
Richmond Hill, Ontario
Canada L4B 3K0		 FAX:
(905) 940-8876

Please fill out the form below and your registration will be processed as soon as possible.

ONLINE REGISTRATION:
First Name:
Last Name:
Job Title/Position:
Company:
Company Address:
City:
Province/State:
Postal Code/ZIP:
Country:
Phone Number:
Fax Number:
Email:
ATTENDEE's Email:
How did you hear about our Webinar?
Please register the following delegate(s) for:

- 25% Discount - for Health Canada and Government Employees, Full Time Students & Academic Faculty
Cheque(s)
- Please make your cheque payable to:
"International Pharmaceutical Academy Inc. "
Company P.O.
- Please bill my company P.O.#
  Credit Card option
- Please contact me for Credit Card information
Visa
Mastercard
Amex
  Promotion Code:
- Please enter your promo code

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