2025 Pacific Pharmacy Seminar Vendor Registration Page 2025 SAFP PACAF Pharmacy Seminar Vendor Registration Form Please enable JavaScript in your browser to complete this form.PLEASE READPlease fill out the following form to the best of your ability. Should you have any questions, please email Maj Miles Bertumen at miles.i.bertumen.mil@health.mil.Vendor Name *Vendor Location *My company is located within the United StatesMy company is located outside of the United StatesVendor Address (CONUS) *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeVendor Address (OCONUS) *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeVendor POC Name *Vendor POC Phone Number *Vendor POC Email *EmailConfirm EmailSponsorship Package Selection(s) *Vendor Registration - $2,300.00Number of Additional Members AttendingTotal Order Summary Item Quantity Total There are no products selected. Sponsorship Package Selection(s) - Vendor Registration1$2,300.00Total$0.00 $0.00Alternatively, vendors can pay via check by completing this form, selecting "Pay with PayPal/Debit/Credit Card, closing the window, and sending a check to: SAFP Treasurer 4501 Rachael Manor Drive Fairfax, VA 22032 Your registration will still be confirmed and a card will not be charged by following these instructions. Pay with PayPal/Debit/Credit Card
