2023 Member Meeting Registration 2023 Member Meeting RSVP General Information Will you attend the 2023 Annual Member Meeting, Jan 20 - 22, 2023? * 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)01/17/202301/18/202301/19/202301/20/2023 Anticipated Arrival Time * (Please Select)MorningMid-DayEvening Anticipated Departure Date * (Please Select)01/21/202301/22/202301/23/202301/24/2023 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 one under 18 permitted. No Yes (guest name)Yes (guest name) Comments or additional requests? Text Text Name Name First First Last Last Paragraph Paragraph Text If you are human, leave this field blank. Submit
