PHARMACY INFORMATION
Pharmacy Name:
NCPDP#:
City:
APCI Stock #:
State:
Zip:
Contact Phone:
Email:
ATTENDANCE TYPE
Select One:
Full Convention
Saturday ONLY
ATTENDEES
Attendee Name:
(Select One)
Child
Guest
Owner
Pharmacist
Pharmacy Tech
Presenter
Representative
Spouse
Stockholder
$0.00
Attendee Spouse/Guest:
(Select One)
Child
Guest
Owner
Pharmacist
Pharmacy Tech
Presenter
Representative
Spouse
Stockholder
$0.00
Additional Guest 1:
(Select One)
Child
Guest
Owner
Pharmacist
Pharmacy Tech
Presenter
Representative
Stockholder
$0.00
Additional Guest 2:
(Select One)
Child
Guest
Owner
Pharmacist
Pharmacy Tech
Presenter
Representative
Stockholder
$0.00
Additional Guest 3:
(Select One)
Child
Guest
Owner
Pharmacist
Pharmacy Tech
Presenter
Representative
Stockholder
$0.00
Additional Guest 4:
(Select One)
Child
Guest
Owner
Pharmacist
Pharmacy Tech
Presenter
Representative
Stockholder
$0.00
Additional Guest 5:
(Select One)
Child
Guest
Owner
Pharmacist
Pharmacy Tech
Presenter
Representative
Stockholder
$0.00
Additional Guest 6:
(Select One)
Child
Guest
Owner
Pharmacist
Pharmacy Tech
Presenter
Representative
Stockholder
$0.00
Thursday, March 21 at The Club at Savannah Harbor
9:30 a.m. shotgun start. Please arrive 30 minutes early.
Cost: $100 per player. Open only to registered attendees of the 2024 APCI Convention.
Limited number of rental clubs available; $65 includes two sleeves of balls. First come, first served.
Box lunch provided, and prizes will be awarded.
Please note:
All attendees for the convention entered above are listed in the box below.. Please check the “Will Play” box by the attendee name if the attendee will take part in the scramble.
For full details, please visit the
Golf Scramble page
Player Name
Will Play
Handicap
Club Rental
Golf Total
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
DINING RESERVATIONS
Friday
QTY
BREAKFAST
LUNCH
Tavern on Fourth
Saturday
QTY
BREAKFAST
LUNCH
Member/Vendor Reception
Sunday
QTY
BREAKFAST
PAYMENT OPTION
Select One:
(Select Payment Option)
YES, please deduct my fees from rebates
I prefer to mail APCI a check for the total
I prefer to use Credit Card
TOTAL DUE
$0.00
IMPORTANT!
Please note:
If paying by credit card, APCI cannot accept credit card payments online. Please
click here to download
the APCI credit card authorization form, then print and fax the form to (205) 277-1087. Credit card payments may also be made by phone by calling Casey Burnett at (800) 532-2724.
For security purposes, please do not send your personal credit card information by email.
Your Registration has been successfully submitted. An email confirmation has been sent.