JULY 7-11, 2021 AT THE SAWGRASS MARRIOTT GOLF RESORT & SPA

1000 PGA TOUR BOULEVARD PONTE VEDRA BEACH, FL

Wednesday Thursday Friday

HOD Board Meeting General CE Track Consultant/General CE Track FPPC Meeting House of Delegates Journal Board Meeting Budget & Finance Meeting Keynote Speaker Address Exhibit Hall & Poster Presentations Pharmacy Foundation Meeting FPPC Reception Local Unit Leaders Meeting FPA Officer Meeting Foundation Student Awards

Saturday Sunday

Consultant/General CE Track Sunday Morning Worship FIPN Breakfast FL Required CE Exhibit Hall Installation of FPA Officers Past Presidents Reception Awards Banquet

Who Should Attend: Pharmacists and Pharmacy Technicians in all areas of practice Registration Deadline June 18, 2021

Accomodations

Sawgrass Marriott Golf Resort & Spa ROOM RATES: $179 plus tax based on single/double occupancy. The room reservation deadline is Friday, June 11, 2021 or when room block is full. Thereafter, reservations may be taken on a space available or rate available basis. There is an optional resort fee. Self-parking is discounted to $10 per day. Please be sure to ask for the Florida Pharmacy Association group rate. All reservations must be accompanied by a first night room deposit or guaranteed with a major credit card. The check-in time is 4:00pm and the checkout time is 11:00 am.

Local Attractions

PGA Tour Headquarters Cabana Beach Club North Guana Outpost World Golf Hall of Fame Lagoon Course at Ponte Vedra Inn & Club TIAA Bank Field Florida Backroads E-Bike Tour (home of the Jacksonville Jaguars) Guana Tolomato Matanzas Beach Volleyball (on property) Bird Island Park The Cultural Center at Ponte Vedra Beach Fantasy Farms Ponte Vedra Concert Hall Village Arts Framing & Gallery Historic Downtown St. Augustine J.T. Vinson Clothier TPC at Sawgrass Stadium Course

COVID 19 Waiver

It is our desire to bring to you an outstanding convention and educational experience while helping everyone to stay safe during this current pandemic. If you, or a member of your party, have traveled to areas where COVID-19 is spreading, or you have been in contact with individuals who have COVID 14 days prior to the convention, we ask that you not participate in this event. By registering for and attending the FPA’s Annual Meeting and Convention, you are acknowledging that an inherent risk of exposure to COVID-19 exists in any public place where people are present. By attending the Annual Meeting and Convention, you and any guests voluntarily assume all risks related to exposure to COVID-19 and agree not to hold the Florida Pharmacy Association and its related event organizers liable for any illness or injury. Participants must agree to the above disclaimer along with wearing masks, exercising social distance, following local health guidelines, and having temperature taken in order to participate at the FPA Annual Meeting and Convention. If you are showing symptoms of possible COVID-19, we will be unable to admit you to the meeting. Keynote Speaker

Scott Knoer, MS, PharmD, FASHP, is the 13th Executive Vice President and Chief Executive Officer of the American Pharmacists Association. He received his BA in psychology from Creighton University in 1988 and his PharmD from the University of Nebraska in 1996. He completed a 2-year administrative residency with a concurrent MS degree in hospital pharmacy from the University of Kansas in 1998.

Before his current leadership role at APhA, Dr. Knoer was the Chief Pharmacy Officer at the Cleveland Clinic from 2011 to 2020, where he led an international pharmacy enterprise with a $1.4 billion dollar drug budget and 1,558 FTEs in 18 hospitals with facilities in Ohio, Florida, and Nevada; Toronto; London; and Abu Dhabi. After graduation from pharmacy school, he was an Operations Manager at the University of Texas Medical Branch at Galveston for 3 years. Moving to Minnesota, he was the Director of Pharmacy at the University of Minnesota Medical Center, Fairview, for a decade before being recruited to the Cleveland Clinic in 2011.

Dr. Knoer has served the profession extensively through involvement in professional organizations at the local, state, and national levels. He is published widely on a variety of pharmacy and leadership topics. He is a frequent invited lecturer to state, national, and international audiences. He is often quoted as a health care expert on a broad array of topics in newspaper, radio, and television outlets.

Dr. Knoer is a passionate advocate for patients and the profession of pharmacy. He has successfully lobbied boards of pharmacy in Ohio and Minnesota to allow the advancement of pharmacy practice, and he has led initiatives that changed Ohio and federal law related to the elevation of pharmacy practice and reducing the impact of drug shortages.

General Conference Information

Disclosures: Financial support, if provided, for educational FPA adheres to the US Food & Drug Administration’s policy activities will be listed in program. Speakers have no on industry supported educational activities. The FDA relevant financial relationship to the activities. policy requires, among other things, that we conduct the Cancellation Policy: If cancellation is made in writing 30 educational program supported by any corporate days prior to the program a refund will be made less a educational grants independently and without control by $10 service charge. If cancellation is made 29-10 days the grantor of the program’s planning, content or prior to the program, a refund will be made, less a $50 execution. Furthermore, the programs must be free of service charge. Cancellation requested in writing after that commercial bias for or against any product. date will result in credit for another FPA CE program valid Each individual attending FPA’s Annual Meeting assumes all for one year. risks associated with his/her attendance and participation Children under the age of 18 are not permitted in the in all on-and off-site activities that occur during this time. educational programs at anytime due to insurance liability By registering for this meeting, you agree to indemnify and issues. This includes children in strollers and carriers. hold harmless, FPA and its governing bodies, officers and The FPA complies with ADA requirements. Please contact the employees from all loss, damage or liability arising out of or office in advance of the meeting for any needed technical related to your attendance and participation at FPA’s assistance. Annual Meeting. Continuing Education Information

Courses appropriate for pharmacists are designated by Florida Pharmacy Association is offering up to 22 contact an ACPE UAN ending in the letter “P” and courses hours during Convention. Each course identifies the appropriate for pharmacy technicians are designated by amount of credit which can be received. A total of 22 an ACPE UAN ending in the letter “T.” contact hours may be obtained from Thursday through Sunday for General (GCE) or Technician (TECH) continuing To earn a statement of credit, participants must complete education. Reducing Medication Errors, HIV/AIDS, and the the necessary information, which includes name, license Validation and Counseling of Prescriptions for Controlled number, NABP number, date of birth, voucher code and Substances are Florida board approved courses. Twelve of evaluation. Statements of credit will be available for you to the offered 22 hours may be used for Consultant Re- download and print four weeks following the meeting. certification (RC). FPA will upload courses to CE Broker and CPE Monitor. It To receive consultant re-certification credit for your is the responsibility of the participant to provide the Florida consultant pharmacist license, you must complete a correct pharmacist license number or pharmacy minimum of 3 hour blocks courses marked RC for partial technician registration number and NABP e-profile credit. The RC courses are offered on Friday and Saturday. information. FPA will NOT re-upload data once upload is There are 6 RC hours on Friday and 6 RC hours on complete. CE Broker offers a reduced subscription rate to Saturday. Florida Board of Pharmacy Consultant Approval FPA members per license cycle. FPA does not offer partial Number is pending. credit for any CPE activity.

The Florida Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a lly Automatica provider of continuing pharmacy education. Up to 22 contact hours are available upon successful completion of Reports to attendance and evaluation from Thursday-Sunday. Statements of continuing pharmacy education credit will available for you to download and print in four weeks. The FPA is also a Florida Department of Health approved provider of continuing education. This is an ACPE application* and knowledge based activity. Speakers have no relevant financial relationship to the activities.

Note: Deadline for ordering printed CE handouts is June 18, 2021

Continuing Education Key: GCE = General CE RC = Recertification Consultant TECH = Technician

2:00 - 4:00 pm Registration Desk Opens

4:00 - 5:00 pm HOD Board Directors Meeting

5:00 - 6:00 pm Florida Pharmacist Political Committee (FPPC) Meeting

6:00 - 7:00 pm Budget & Finance Committee Meeting

7:30 pm Florida Pharmacy Association Officers Meeting 7:00 am Registration Desk Opens

7:30 am Welcome and Introductions

8:00 - 10:00 am Delegate Registration

7:45 - 9:15 am Legislative Update 2021 Michael Jackson, BPharm, CPh, Executive Vice President and CEO, Florida Pharmacy Association Upon completion of this activity, pharmacists will be able to: Describe the recent and proposed changes to Florida laws related to the practice of pharmacy; Execute changes within the pharmacy to maintain compliance with current Florida laws; Explain how revisions to the pharmacy practice act and rules may help technicians in their efforts to support pharmacist services. Upon completion of this activity, technicians will be able to: Recognize the recent and proposed changes to Florida laws related to the practice of pharmacy; Identify changes within the pharmacy to maintain compliance with current Florida laws; Explain how revisions to the pharmacy practice act and rules may help technicians in their efforts to support pharmacist services.

1.5 hrs GCE/TECH UAN: 0165-0000-21-032-L03-P UAN: 0165-0000-21-032-L03-T

9:20 - 10:50 AM New Drug Update 2020-2021 Shawn Bridley, PharmD, BCGP, CPh, cMTM, MHP, Board Certified Geriatric Pharmacist, Owner, Care Dynamics Senior Care Upon completion of this activity, pharmacists will be able to: Briefly discuss updated CDC Immunization recommendations; Describe the current information concerning newly FDA approved medications; Discuss (pharmacology, pharmacokinetics, efficacy and safety data, drug interactions, dosing, monitoring, and cost) in the selection of evidence-based pharmacotherapy. Upon completion of this activity, technicians will be able to: Recognize new drugs released in 2020-2021; Identify indications of newly released drugs; Identify recommendations by the CDC for immunizations.

1.5 hrs GCE/TECH UAN: 0165-0000-21-033-L01-P UAN: 0165-0000-21-033-L01-T

11:00 am - 1:00pm House of Delegates & Annual Business Meeting 12:00 - 1:00 pm Lunch on your own

1:00 - 2:00 pm Bypassing Burnout: Establishing Resiliency as a Journey Instead of a Destination Stacey D. Curtis, PharmD, Clinical Assistant Professor, Pharmacotherapy and Translational Research, University of Florida College of Pharmacy Upon completion of this activity, participants will be able to: Define the signs and symptoms of burnout; Describe methods to mitigate burnout and improve well- being; Discuss the characteristics of resiliency; Develop individual intentional practices to foster resiliency and well-being; Identify strategies that improve positive change within organizations to influence resiliency and well-being. Upon completion of this activity, technicians will be able to: Define the signs and symptoms of burnout; Describe methods to mitigate burnout and improve well-being; Discuss the characteristics of resiliency; Develop individual intentional practices to foster resiliency and well-being; Identify strategies that improve positive change within organizations to influence resiliency and well-being.

1 hr GCE/TECH UAN: 0165-0000-21-034-L04-P UAN: 0165-0000-21-034-L04-T

2:05 - 3:05pm Keynote Address: Empowering Pharmacists to Care for Patients Scott Knoer, M.S., Pharm.D., FASHP, Executive Vice President and CEO, American Pharmacists Association Upon completion of this activity, pharmacists will be able to: Identify significant disruptive innovations that will impact healthcare; Describe the need for payment reform and provider status at the national and state levels; Describe the importance of advocacy in professional advancement. Upon completion of this activity, technicians will be able to: Identify significant disruptive innovations that will impact healthcare; Describe the importance of changing financial reimbursement models for pharmacy services; Describe the importance of technician certification.

1 hr GCE/TECH UAN: 0165-0000-21-035-L04-P UAN: 0165-0000-21-035-L04-T

3:30 - 5:30 pm House of Delegates Reconvenes

6:00 - 7:00 pm FPPC Reception 8:00 pm President's 250 Club Reception 7:00 am Registration Desk Opens

7:45 - 9:15 am Pharmacist in Action During the COVID-19 Pandemic Crisis Kathleen Jodoin, PharmD, BCPS, Pharmacy Clinical Coordinator, Mount Sinai Medical Center Upon completion of this activity, pharmacists will be able to: Discuss SARS-CoV-2 transmission and explain the severity of its progression; Describe the evolution of treatment options and identify emerging treatment strategies for COVID-19; Discuss the available COVID-19 vaccine options and high risk patient populations recommended for vaccination; Identify sedation strategies in the ICU that clinicians may utilize in the treatment of COVID-19 positive patients; Identify drug shortage challenges facing health-systems due to COVID-19; Identify leadership and logistical strategies to successfully communicate changes and overcome operational hurdles during a pandemic crisis. Upon completion of this activity, technicians will be able to: Define COVID-19; Review the Coronaviridae virus and discuss factors and disease progression; Identify potential prevention and treatment options for COVID-19.

1.5 hrs GCE/TECH/RC UAN: 0165-0000-21-036-L01-P UAN: 0165-0000-21-036-L01-T

9:00 - 10:00 am Journal Board Meeting

9:20 - 10:50 am The Impact of COVID on the Mind, Mood, and Memory Angela Hill, Pharm.D., CRPh, Professor & Associate Dean of Clinical Affairs, Project Director, WE-CARE, Taneja College of Pharmacy, University of South Florida Upon completion of this activity, pharmacists will be able to: Describe the prevalence of mood disorders and suicide associated with past and current epidemics and pandemics; Discuss the impact of COVID infection on the brain and its functions; Explain the risk factors and implications of COVID infection for Alzheimer’s disease and other memory impairing disorders; Develop competency in selecting, and monitoring the newer antidepressants based on select patient characteristics; Provide recommendations for counseling patients with depression through case-based discussions; Choose resources for health professionals and the public to assist with mood, memory, and mind issues. Upon completion of this activity, technicians will be able to: Recognize the prevalence of mood disorders and suicide associated with past and current epidemics and pandemics; Discuss the impact of COVID infection on the brain and its functions; List the risk factors of COVID infection for Alzheimer’s disease and other memory impairing disorders.

1.5 hr GCE/TECH/RC UAN: 0165-0000-21-037-L01-P* UAN: 0165-0000-21-038-L04-T

11:00 am - 1:00 pm Exhibit Hall Grand Opening 11:00 am - 1:00 pm Poster Presentations 12:00 - 1:00 pm Lunch on your own 1:00 - 2:30 pm Local Unit Leaders Meeting

1:00 - 2:30 pm Anticoagulation in the Time of COVID Katherine Vogel Anderson, Pharm.D., BCACP, Associate Professor, Faculty Senate Chair, University of Florida Colleges of Pharmacy and Medicine Department of Pharmacotherapy and Translational Research, Division of General Internal Medicine Upon completion of this activity, pharmacists will be able to: Discuss thromboembolism risk associated with COVID-19; Provide recommendations for anticoagulation therapy in the management of COVID-19; Review available evidence regarding anticoagulation therapy for COVID-19 patients. Upon completion of this activity, technicians will be able to: Review thromboembolism risk for patients with COVID-19; Discuss anticoagulant drugs, dosages, and regimens used in the treatment of COVID-19; Determine risks and benefits of using anticoagulation therapy in treating COVID-19.

1.5 hrs GCE/TECH/RC UAN: 0165-0000-21-039-L01-P UAN: 0165-0000-21-039-L01-T

2:35 - 4:05 pm Nutrition and Supplements to Support the Immune System Lynn Lafferty, PharmD, ND, MBA, DACBN, Endowed Professor, Assistant Professor of Pharmacy Practice Nova Southeastern College of Pharmacy Upon completion of this activity, pharmacists will be able to: Review Biochemical and Physiological Principals of the Immune System; Discuss how Clinical and Functional Nutrition enhances the Immune System; Recite the tenets of Herbal Medicine and Supplementation Practices; Discuss how to incorporate nutrition into pharmacy practice. Upon completion of this activity, technicians will be able to: Recognize the principals of clinical and functional nutrition; List the tenets of herbal medicine; List ways to incorporate nutrition into pharmacy practice.

1.5 hrs GCE/TECH/RC UAN: 0165-0000-21-040-L01-P UAN: 0165-0000-21-040-L01-T

7:00 pm Foundation Celebration Student Awards 6:30 - 7:30 am Florida Independent Pharmacy Owner Breakfast (RSVP at 850-656-0100)

7:00 am Registration Desk Opens

7:45 - 9:15 am Keeping Up with Immunizations: Helping Your Community Elias B. Chahine, PharmD, FCCP, FASCP, FFSHP, BCPS, BCIDP, FSHP President-Elect, Professor of Pharmacy Practice Gregory School of Pharmacy, Palm Beach Atlantic University Upon completion of this activity, pharmacists will be able to: Assess adult patients for risk factors for common vaccine-preventable diseases; Distinguish between the various available vaccines for influenza; pneumococcal disease; herpes zoster; tetanus diphtheria pertussis; hepatitis A; hepatitis B; and human papillomavirus; Design a patient-specific immunization regimen on the basis of age, risk factors, and comorbid conditions; Describe the role of pharmacists and pharmacy technicians in immunization advocacy and delivery; Delineate strategies for effectively addressing pseudo-science and vaccine hesitancy. Upon completion of this activity, technicians will be able to: List for risk factors for common vaccine-preventable diseases; Identify the various available vaccines for influenza; pneumococcal disease; herpes zoster; tetanus diphtheria pertussis; hepatitis A; hepatitis B; and human papillomavirus; Describe the role of pharmacists and pharmacy technicians in immunization advocacy and delivery; State two strategies for addressing vaccine hesitancy.

1.5 hrs GCE/TECH/RC UAN:0165-0000-21-041-L06-P* UAN: 0165-0000-21-042-L06-T

9:20 - 10:50 am MTM and Pharmacists - #1 Clinical Service We Should Be Known For Jonathan G. Marquess, PharmD, CDCES, FAPhA, President/CEO, The Institute for Wellness and Education, Inc Upon completion of this activity, pharmacists will be able to. State the core elements of medication therapy management (MTM) services and summarize changes to MTM criteria; Outline the key habits to be covered in a medication therapy management session; Access tools and resources available for pharmacist to develop and provide MTM services; List barriers to providing MTM services in a pharmacy; Review cases that utilize MTM for patients with diabetes that is recommended and needed for patient and provider success. Upon completion of this activity, technicians will be able to: Identify the core elements of medication therapy management (MTM) services; Recognize tools and resources available in the pharmacy to provide MTM services; List barriers to providing MTM services in a pharmacy.

1.5 hrs GCE/TECH/RC UAN: 0165-0000-21-043-L04-P UAN: 0165-0000-21-043-L01-T

11:00 am - 1:00 pm Exhibit Hall Opens 12:00 - 1:00 pm Lunch on your own

1:00 - 2:30 pm Test and Treat: Florida Pharmacy Practice and Physician Collaboration Daniel E. Buffington, PharmD, MBA, FAPhA, President, Clinical Pharmacology Services, Inc. Upon completion pharmacists will be able to: Review of Florida regulations concerning pharmacists and pharmacy practice; Outline the existing scope of practice and recent legislative additions to pharmacy practice (i.e., Chronic Care Management, Test & Treat, and Consultant Pharmacist licensure, etc.); Demonstrate the design, implementation, and utilization of various Physician and Pharmacist practice agreements. Upon completion technicians will be able to: Define Collaborative Practice Agreements; Recognize Florida rules concerning pharmacists and pharmacy practice; Recognize recent legislative changes to the practice of pharmacy.

1.5 hrs GCE/TECH/RC UAN: 0165-0000-21-044-L04-P UAN: 0165-0000-21-044-L04-T

2:35 - 4:05 pm Prescription Department Manager: Role and Responsibilities Mark W. Mikhael Pharm. D., ProHealth Pharmacy Solutions, Chief Pharmacy Officer Upon completion of this activity, pharmacists will be able to: Discuss the responsibilities of the Prescription Department Manager (PDM); Identify training that may help the PDM; Describe common misunderstandings regarding the role of the PDM; Discuss the consequences for not following the rules. Upon completion of this activity, technicians will be able to: Recognize the responsibilities of the Prescription Department Manager (PDM); Identify training that may help the PDM; List the consequences for not following the rules.

1.5 hrs GCE/TECH/RC UAN: 0165-0000-21-045-L03-P UAN: 0165-0000-21-045-L03-T

5:00 - 6:00 pm Past Presidents Reception (Invitation Only) 7:00 pm Awards Banquet 6:45 - 7:45 am Morning Worship

7:00 am Registration Desk Opens

7:45 - 9:45 am Reducing Medication Errors through Implementing a Continuous Quality Improvement Program Michael Jackson, BPharm, CPh, Executive Vice President and CEO, Florida Pharmacy Association Upon completion of this activity, pharmacists will be able to: Define elements of a Continuous Quality Improvement (CQI) Program; Restructure a pharmacy practice to address quality related events; Discuss how to use Root Cause Analysis (RCA) to prevent errors; Implement an action plan to address quality of care in pharmacies with a goal towards error reduction and prevention; Recite quality improvement regulations for Florida pharmacies; Implement programs to improve patient safety in pharmacy health care systems. Upon completion of this activity, technicians will be able to: Define CQI; Discuss RCA; List most common medication errors; Employ techniques to reduce medication errors by using CQI.

2 hrs GCE/TECH UAN: 0165-0000-21-046-L05-P UAN: 0165-0000-21-046-L05-T

9:50 - 10:50 am HIV/AIDS Update 2021 Briana Journee, PharmD, MPh, Assistant Professor, Florida A & M University, College of Pharmacy Upon completion of this activity, pharmacists will be able to: Review current modes of transmission; Identify high risk behaviors; Discuss the pharmacist role in providing care for HIV infected patients; Describe the mechanism of actions of antivirals; Describe the rationale behind combination therapies; Interpret current Florida law on HIV/AIDS. Upon completion technicians will be able to: Define HIV and AIDS; List methods of transmission of HIV/AIDS; Identify high risk behaviors; Recognize current Florida law on HIV/AIDS.

1 hr GCE/TECH/RC UAN: 0165-0000-21-047-L02-P UAN: 0165-0000-21-047-L02-T

10:55 - 11:15 am Installation of New FPA Officers! 11:15 - 11:25 am Break

11:25 - 1:25 pm Validation and Counseling of Prescriptions for Controlled Substance and Opioids Joseph Cammilleri, PharmD, BCACP, CPE, Ambulatory Care Clinical Pharmacist, Pain Management, PGY2 Pain/Palliative Care Program Director, UF Health Upon completion of this activity, participants will be able to: Describe how to ensure access to controlled substances for all patients with a valid prescription; Use the Prescription Drug Monitoring Program’s Database; Assess prescriptions for appropriate therapeutic value; Detect prescriptions that are not based on a legitimate medical purpose; Discuss the laws and rules related to the prescribing and dispensing of controlled substances; Discuss proper patient storage and disposal of controlled substances; Discuss protocols for addressing and resolving problems recognized during the drug utilization review; Provide education on section 381.887, F.S., emergency treatment for suspected opioid overdoses and on the State Surgeon General’s Statewide Standing Order for Naloxone; Counsel patients with opioid prescriptions; and Provide available treatment resources for opioid physical dependence, addiction, misuse, or abuse. Upon completion technicians will be able to: Use the Prescription Drug Monitoring Program’s\Database; Assess prescriptions for appropriate and accurate information; Recognize the laws and rules related to the prescribing and dispensing of controlled substances.

2 hrs GCE/TECH/RC UAN: 0165-0000-21-048-L03-P* UAN: 0165-0000-21-048-L03-T*

Save the Date!

132ND ANNUAL MEETING & CONVENTION JULY 6-10, 2022 MARRIOTT HARBOR BEACH RESORT & SPA FT. LAUDERDALE Full Conference Single Day Individual Event Registration Extras (Member / Non-member) (Member / Non-member) Members not registered for full convention CE Handbook $40 Pharmacist $345 / $525 $165 / $215 House of Delegates $165 FPA Polo Shirt $35 Student $150 $50 / $70 Exhibit Hall $30

Technician $155 / $175 $65 / $90 Awards Reception $80 Deadline to order printed CE Handouts is JUNE 18, 2021 Student Awards $50 Full Conference registration includes Educational Programs Thursday- Deadline to order a Polo Shirt is Sunday, House of Delegates on Thursday, Exhibit Hall Friday and JUNE 4, 2021 Saturday, Receptions, and Awards Event on Saturday

Registration Form Please Check One: I am an FPA Member I am NOT an FPA Member

Name: ______Address: ______

FL License #: ______City: ______State: ______Zip: ______

NABP e-Profile #: ______DOB (MM/DD): ______Phone: ______Email: ______

Emergency Contact Name: ______

Emergency Contact Phone Number: ______

Individual Event Tickets for Guests Are you interested in a Golf Outing? Guest Name(s): ______Yes No

Full Conference Registration: Single Day Registration: Individual Event Registration:

Pharmacist Technician Student Pharmacist Technician Student House of Delegates (Thursday) Register by June 10 Registration + Membership (Pharmacist) Registration Date(s): Exhibit Hall (Qty: ___ ) Registration + Membership (Technician) Thursday (HOD) Friday Awards Reception (Qty: ___ ) Saturday Sunday Student Awards (Qty: ___ )

Extras: CE Handbook FPA Polo Shirt FPPC Donation $ ______Style: Male / Female Size: Small / Medium / Large / XL

Credit Card Payments: Method of Payment (Checks made payable to FPA): AMEX Discover Visa Mastercard Amount Authorized: $______Check Credit Card Card Number: ______Exp Date (MM/YY): ______Security Code:______Billing Address: ______C/S/Z: ______Signature: ______

Mail To: 610 N Adams St., Tallahassee, FL 32301 Phone: (850) 222- 2400 | Fax: (850) 561-6758