2022 National Diamondback Pharmacy Alumni Council 52nd Annual Meeting and Continuing Education Program

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Florida A&M University College of Pharmacy and Pharmaceutical Sciences
Continuing Education Attendance Form
Tallahassee, Florida

Reminder: If we do not receive all of the required information listed below, we will not
be able to issue your CE credit hours or submit them to CE Broker or CPE Monitor.

Email *

Name *

Full Address *

Daytime Phone Number *

DOB (MM/DD) *

NABP E-Profile# *

Florida License Number (General PS) *

Yes

Required

Saturday, June 25, 2022 - 2 Contact Hours *

Yes

Required

Sunday, June 26, 2022 - 2 Contact Hours *

Yes

Required

Are you a FAMU COPPS Graduate? *

Yes

Required

Continuing Education Program Payment *

Free for Members

$75.00 for non-members (For FAMU grads, the fee will be applied to membership dues for 2022-2023)

PayPal-ndpac1972@gmail.com, PayPal-$NDPAC, Check-NDPAC, PO Box 530935, St. Petersburg, FL 33747

Send me a copy of my responses.

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