Nova Scotia Association of Hospital Pharmacist Managers

REGISTRATION FORM Please complete the following: Name: Title: E-mail: Address: Postal Code: Hospital/Company: Business Phone: ( ) Fax: ( )

Please indicate which registration fee applies: Please make cheque payable to: Research Fund T-828 ______Pharmacist - $30 ______Pharmacy Technician/Assistant - $20 ______Pharmacy Student - $20 (Note: registration is limited to 10 students) ______NSHA (all Zones) pharmacy staff - Free, however if unable to attend you must cancel by September 26 or your cost centre will be charged $30 for catering costs Registration is limited. Deadline to cancel and receive a full refund is September 26. ABSTRACT Deadline: Wednesday, September 13, 2017 REGISTRATION Deadline: Friday, September 22, 2017 Mark an “X” on your preference:

Breakout Session ___ 1. Pharmacist Prescribing in the ED OR ___ 2. Drug Information System (DIS): Applications & Ethics Meals: Coffee/tea in the morning, lunch and refreshments are included in the registration fee. Meatless options will be available. Check if appropriate:  I have a food allergy to . Hotel Information: If you require accommodations while in Halifax, the following hotels are close to the Victoria General: Atlantica Hotel, 1980 Robie Street, Reservations: 888-810-7288 The Lord Nelson, 1515 South Park Street, Reservations: 800-565-2020 Cambridge Suites Hotel, 1583 Brunswick Street, Reservations: 800-565-1263 Ask for Cambridge Cares program: $2 will be donated to the QEII Foundation. Parking: Available on the street (free) or in the Victoria General Hospital lot ($4 or $2 with Central Zone staff ID) Email (preferred) this completed Registration Form to Alanna McQuaid, [email protected], or fax to 902-473-1606, Attention: Alanna McQuaid, by September 22. You may bring payment (exact change) on the day of the conference or mail a cheque payable to Research Fund T-828 to: Alanna McQuaid Room 2043, Pharmacy, Victoria General 1276 South Park Street Halifax, Nova Scotia B3H 2Y9

Abstracts Submissions: email to Heather Neville [email protected] by September 13.

THIS PROGRAM HAS BEEN SUBMITTED FOR CONTINUING EDUCATION CREDITS