Community Pharmacy Humber Flu Training - Expression of Interest

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* 1. Please provide the following pharmacy information:

Pharmacy Name

Pharmacy Address

Pharmacy ODS Code

Pharmacy Email Address

Pharmacy Telephone Number

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* 2. How many people from your pharmacy would like to attend Flu training?

1

10

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 3. Additional Comments?