Pharmacist Ordering and Interpretation of Laboratory Tests Provincial Program Only

Pharmacist Ordering and Interpretation of Laboratory Tests

Provincial Program Only
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Pharmacist License Number*
Subtotal
HST
Amount Owing

Registration Payment*

CADDescription

Credit Card (VISA or Mastercard only, cannot accept AMEX or Visa Debit)
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

This information is collected and maintained by the School of Pharmacy to administer the Pharmacy Technician Injection Program as accredited by the Newfoundland Labrador Pharmacy Board and use for no other reason. The information on this form is collected under the authority of the Access to Information and Protection of Privacy Act, 2015 (SNL2015 Chapter A-1.2). Questions about the collection and use of this information may be directed to the Senior Administrative Office, School of Pharmacy at 709-864-7128 or pharminfo@mun.ca.
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