2022 Member Meeting Registration 2022 Member Meeting RSVP General Information Will you attend the 2022 Annual Member Meeting, Jan 28-30, 2022? * Yes No Member First Name * Member Last Name * Pharmacy Name * Email * Mobile Phone Number * May we send text messages with meeting information to this number? * Yes No Home Address * Home Address Address Line 1 Address Line 1 Address Line 2 Address Line 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Guest Information Do you plan to bring additional guests? Yes No How many guests? 12345 Guest 1 Please list spouse, children or other guests that will be traveling with you to the CARE Member Meeting. Is guest staff or family? StaffFamily Guest Title Guest Relationship Is guest at least 18 years of age? No (please list age)No (please list age) Yes Guest First Name * Guest Last Name * Guest 2 Please list spouse, children or other guests that will be traveling with you to the CARE Member Meeting. Is guest staff or family? StaffFamily Guest Title Guest Relationship Is guest at least 18 years of age? No (please list age)No (please list age) Yes Guest First Name * Guest Last Name * Guest 3 Please list spouse, children or other guests that will be traveling with you to the CARE Member Meeting. Is guest staff or family? StaffFamily Guest Title Guest Relationship Is guest at least 18 years of age? No (please list age)No (please list age) Yes Guest First Name * Guest Last Name * Guest 4 Please list spouse, children or other guests that will be traveling with you to the CARE Member Meeting. Is guest staff or family? StaffFamily Guest Title Guest Relationship Is guest at least 18 years of age? No (please list age)No (please list age) Yes Guest First Name * Guest Last Name * Guest 5 Please list spouse, children or other guests that will be traveling with you to the CARE Member Meeting. Is guest staff or family? StaffFamily Guest Title Guest Relationship Is guest at least 18 years of age? No (please list age)No (please list age) Yes Guest First Name * Guest Last Name * Rooming Information CARE will pay for one room per member location on Friday and Saturday nights. Room Reservations will be managed by Erin Dougherty on behalf of CARE Members. Any issues or questions should be directed to Erin at [email protected]. Anticipated Arrival Date * (Please Select)01/26/202201/27/202201/28/202201/29/2022 Anticipated Arrival Time * (Please Select)MorningMid-DayEvening Anticipated Departure Date * (Please Select)01/27/202201/28/202201/29/202201/30/2022 Anticipated Departure Time * (Please Select)MorningMid-DayEvening Bed Preference * --Select--King2 QueensN/A Additional nights will be billed at the CARE discounted nightly rate of $199 per night to you at checkout. Do you need adjoining rooms? Yes (If so, for how many people?)Yes (If so, for how many people?) No Dining and Food Options Do you or your guests have any food allergies or dietary restrictions? * No Yes (please list name of person and explain, i.e. allergies, Kosher, etc.)Yes (please list name of person and explain, i.e. allergies, Kosher, etc.) Will you be attending Saturday evening’s dinner event? * No Yes If yes, will you be bringing a guest to Saturday’s main dinner event? No Yes (guest name)Yes (guest name) CARE pays for member and one adult guest (over 16) per member location. There will be a separate dinner provided for additional guests and family. Comments or additional requests? If you are human, leave this field blank. Submit
