The information
below WILL NOT APPEAR on
the AZO pages on the web.
It will be forwarded to the Supreme Signare and Director of Mailing.
To make any changes to
your registration
SIMPLY RE-REGISTER! |
Please provide all of the
following information for the AZO National Data Base:
this information will be sent to the Director of Mailing, Lou Flacks, PSD
and the Director of Fraternal Affairs, Bruce Strell, PSD
All information will be held in
strict confidence by Supreme Chapter.This
information will not be shared or sold.
First Name: Last
Name:
Title:
Street Address:
Apartment#:
City:
State: Zip Code:Country:
Home Phone:
Fax:
Email:(Required)
Chapter
Affiliation:
Pharmacy School:
Induction Date
(mm/dd/yyyy):
Graduation Date:
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