9-6-23 CEU Form Name First Last Street Address* City* State* Zip* Phone*Email* Profession Type*Pharmacist/Pharmacy TechNurseAdministratorLicense Number*(FL Pharmacists: include PS number only) For pharmacists/pharmacy techs*Include your NABP number and DOB (mm/dd). BOTH numbers are required in order to report. Did the speaker achieve the goals and objectives provided for this program?*YesNoWill the information presented benefit you in your daily practice?*YesNoDid the sponsor's presentation provide useful information you can use in your practice?* Yes No Additional commentsPlease share any additional information you’d like to share from your participation in this activity. Δ
