Pharm4Me Brochure Request Form

If you would like to order Pharm4Me brochures (free of charge!) for your recruitment efforts, please complete the form below, noting the following:

The maximum request amount is 200 brochures per year.
We are anticipating a high response for brochures, and therefore, request your patience as we work to fulfill orders. We anticipate a one month turnaround to receive brochures.
If you need more than 200 brochures or would like these immediately, you are welcome to print the brochures on your own. The Pharmacy is Right for Me Recruitment Materials page on the AACP website has a PDF that you can download and information on the service AACP uses for printing.

Recipient's Name for Mailing *

Address: Line 1 *

Address: Line 2

Address: Line 3

City *

State *

Zip Code *

Email Address *

Phone Number *

Name of Institution or Organization

Please enter the number of brochures you are requesting: *

Please click Submit when finished.

Please allow up to one month for your shipment to arrive.