Call for Nominations....Dinner Dance Honoree

The award will be presented at the Italian-American Pharmacists Society Annual Dinner Dance.

The award is to honor an individual that has an Italian-American Heritage

and has either been a great support to us in pharmacy or who has been exceptional in the practice of pharmacy.

There is also a choice to forgo any nominations, in which case the Dinner Dance will not have any honoree.

Fill in Nominee Information: (please fill in as much as you know)

Nominee Name__________________________________

Address________________________________________

City, State, Zip__________________________________

Phone_________________________________________

E-Mail________________________________________

Enter your supporting comments in the space provided below:

Fill in your information: --------Today's Date__________

Name__________________________________________

Address________________________________________

City, State, Zip__________________________________

Phone_________________________________________

E-Mail________________________________________