Arkansas Pharmacists Association 121th Annual Convention June 12

Arkansas Pharmacists Association
126th Annual Convention

June 12 - 14, 2008
Big Cedar Lodge
Ridgedale, MO

Please provide all information requested in the form below. When your form is complete, select the "Register" button at the bottom of this page. If there is an error in sending your registration, please print this form, complete it manually and submit it with your checks or credit card information by mail to APA, 417 South Victory, Little Rock, AR 72201 or by fax at 501-372-0546.

Click here to view a Preliminary Convention Program
Program Learning Objectives

Reserve your hotel room now at
http://www.big-cedar.com/rates
or call 1-800-225-6343
Check for room availability.
Mention APA for group rates.

APA Convention Registration Form

Last Name
First Name
Designation	P.D. Ph.D. Pharm.D. Technician Student Other
Nickname for Badge
Affiliation (pharmacy, etc.)
Street Address
City
State
Zip
Telephone
FAX
E-Mail
Arkansas Pharmacist License No.
	Is this your first APA Convention? Yes No
	APA Past President ?
Membership Status	APA Member APA Non-Member

FULL REGISTRATION PACKAGE

APA MEMBERS
INCLUDES: All education sessions, receptions, exhibits, prize drawings, continental breakfasts, Friday Night Party and Saturday - "An Evening with the Presidents" (All special events tickets are included in this price.) (AP-PAC breakfast is a separate event and is not included in the registration package.)

APA Members - Full Registration Package

	By May 30, 2007.....................................$195.00
	After May 30, 2007.................................$225.00

APA Member and Spouse/Guest Full Registration Package (Best Value)
*If you and your spouse are pharmacists, separate registration forms and fees are required.

By May 30, 2007.....................................$295.00

After May 30, 2007.................................$325.00

Spouse/Guest Name

APA Members - Daily Registration Package
INCLUDES: All education sessions, receptions, exhibits, prize drawings, continental breakfasts, and social events for that day. (Special events tickets for that day are included in this price.)

(Please select the day you will attend.)

APA Member Daily Package

	Thursday.....................................$155.00
	Friday...........................................$155.00
	Saturday......................................$155.00

APA Member and Spouse/Guest Daily Package

	Thursday.....................................$195.00
	Friday...........................................$195.00
	Saturday......................................$195.00

APA NON-MEMBERS
INCLUDES: All education sessions, receptions, exhibits, prize drawings, continental breakfasts, and social events tickets for Thursday through Saturday.

APA Non-Member Full Registration Package

	By May 30, 2007....................................$285.00
	After May 30, 2007................................$315.00

APA Non-Member and Spouse/Guest Full Registration Package (Best Value)

By May 30, 2007.....................................$385.00

After May 30, 2007.................................$405.00

Spouse/Guest Name

APA Non-Members - Daily Registration Package
INCLUDES: All education sessions, receptions, exhibits, prize drawings, continental breakfasts, and social events tickets for that day. (Special events tickets for that day are included in this price.)

(Please select the day you will attend.)

APA Non-Member Daily Package

	Thursday......................................$185.00
	Friday...........................................$185.00
	Saturday......................................$185.00

APA Non-Member and Spouse/Guest Daily Package

	Thursday.....................................$230.00
	Friday..........................................$230.00
	Saturday......................................$230.00

TECHNICIAN REGISTRATION PACKAGE

Pharmacy Technician Full Registration Package
(All Social events tickets are included in this price.)

	.......................................................$135.00 member
	.......................................................$170.00 non-member

Pharmacy Technician Daily Registration Package
(Special event tickets for that day are included in this price.)

(Please select the day you will attend.)

	Thursday.....................................$80.00 member
	Friday..........................................$80.00 member
	Saturday......................................$80.00 member

	Thursday.....................................$100.00 non-member
	Friday..........................................$100.00 non-member
	Saturday......................................$100.00 non-member

ADDITIONAL ACTIVITIES

Wednesday - Golf Tournament...........$75.00 per person

Quantity
x $75.00	$Total

Friday - Spouse Event(s)
Please check the event(s) that you would like to attend.
Name
Culinary Demo - 9:30 a.m.
Bunko/Wine and Cheese Tasting - 2:00 p.m.
$ Total

Pharmacy Student Sponsorship....$85.00 per person
This will give any UAMS College of Pharmacy Student a chance to attend convention.

Quantity
x $85.00	$Total

EXTRA SOCIAL EVENTS TICKETS

Tickets for the following events are included in the convention registration package. Extra tickets may be purchased for additional guests.

Tickets must be purchased 24 hours prior to the event.

Friday Night Chuckwagon Dinner................................................................$50.00

Quantity
x $50.00	$Total

SPECIAL OFFERING

Saturday Night - Showboat Branson Belle........$52.00

Quantity
x $52.00	$Total

Total Due

PAYMENT METHOD

	Check Payable to APA - Check Number
Credit Card	American Express MasterCard Visa Discover
Name on Card
Card Number

Expiration Date

AP-PAC Luncheon
Saturday, June 14, 2008
12:00 noon - 1:30 p.m.
$60 per person

I would like tickets for the AP-PAC luncheon.

Please send check payable to:
AP-PAC
417 South Victory
Little Rock, AR 72201

AP-PAC Luncheon tickets are available by check payable to AP-PAC only. Credit cards are not accepted.