2018 Pharmacy Legislative Day
Join hundreds of pharmacy professionals at the State Capitol on March 7, 2018! Represent your profession and speak directly Photo ID: All persons visiting the Capitol Building must present a to legislators and staff regarding the critical government issued photo ID. issues facing pharmacy. It is vital that your legislators become more knowledgeable on the Motorcoach: Bus transportation to and from Springfield will be available. role of pharmacy in augmenting healthcare. Be sure to mark your pickup location below. Departure times to follow. Learn about key issues and how to discuss them with your legislators. Join your fellow pharmacists, students & techs and become part of the solution. Don’t miss this opportunity to let your collective voices be heard! Jointly sponsored by Illinois Council of HealthSystem Pharmacists and the Illinois Pharmacists Association. For the past nine years, ICHP and IPhA have joined forces to let lawmakers know that pharmacists stand united.
Schedule of Events (tentative) 10:30 am - 12:30 pm
Check In Auditorium, Howlett Building
11:00 am - 12:15 pm Lunch Hall of Flags, Howlett Building 12:30 pm - 2:00 pm
CPE Legislative Orientation Auditorium, Howlett Building
2:30 pm - 4:45 pm
Capitol activities including legislator visits Government issued ID is required
5:15 pm
Bus Departure
Illinois Council of Health-System Pharmacists
Registration Deadline: February 21, 2018
Register online beginning 1/2/18 at www.ichpnet.org or complete paper registration form below. Fax registration to (815) 227-9294 | Mail registration to ICHP, 4055 N. Perryville Road, Loves Park, IL 61111-8653 Name: ____________________________________________________ Registered Voting Address:___________________________________ City:____________________________ State:_____ Zip+4: __________ Cell Phone (Required if you are riding the bus): (_____) _____-__________ Email (Required for event updates): _________________________________ My State Representative is: ___________________________________ My State Senator is: __________________________________________
q I need vegetarian meals q Other special needs: _______________________________
I am currently a member of:
q ICHP q IPhA q Both q Neither
Emergency Contact Name: ___________________________ Phone: ____________________ q Yes, I would like to attend Legislative Day! (Registration includes lunch.) q Member Student (please indicate school below) ........................................... $10 q CSU q MWU q RFU q RU q SIUE q StLCOP q UIC-C q UIC-R
q Member Technician ................................................................................... $10 q Member Pharmacist .................................................................................. $25 q Non-member ............................................................................................. $125
q
Yes, I will be riding the Motorcoach. (Additional cost.) (Registration deadline 2/21/18 for Motorcoach.)
q Student/Technician ........................................................................... $15 q Pharmacist ............................................................................................ $25 Riding to/from the following College of Pharmacy: q CSU q RU q UIC-Chicago q MWU q SIUE q UIC-Rockford q RFU q StLCOP Payment Information TOTAL $________ q Check enclosed payable to Illinois Council of Health-System Pharmacists q Charge my credit card Credit Card Account: # _____________________________________ Exp. Date: ________ CVV Code: ________ Billing Zip Code: __________ Name on Card: __________________________________________ Signature: ______________________________________________ You MUST be pre-registered to attend 2018 Pharmacy Legislative Day!
By registering for Pharmacy Legislative Day, you are giving ICHP and IPhA permission to use photographs or video of yourself taken at the event. ICHP and IPhA intend to use such photographs and videos only in connection with ICHP and IPhA official publications, media promotions, web sites, or social media sites including but not limited to Facebook, Instagram, Twitter, and YouTube, and that these images may be used without further notifying you. Cancellation Policy: Cancellation must be received 7 days in advance of the event for a full refund and 48 hours in advance in order to receive a refund of 50% of fees paid. Cancellations of less than 48 hours and “no shows” will receive no refund.