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* 1. First and Last Name

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* 2. Preferred email

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* 3. Please indicate your primary working environment.

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* 4. Choose the option that best applies to you.

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* 5. We are offering a 30-minute online session in December to explain this opportunity further. Please indicate your availability for one of the two time slots below.

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* 6. Would you like to be notified of any future pharmacy technician professional learning opportunities?

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