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10 TH ANNUAL RX MIXER PRESENTS: BENEFITING THE IACP FOUNDATION SUNDAY, MAY 18, 2014 ~ 6:30PM – MIDNIGHT Crystal Gateway Marriott, Grand Ballroom, Arlington, Va. PROSPECTUS

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Page 1: PROSPECTUS - cdn.ymaws.com...Digi-Trax Corporation DYNALABS EMD Millipore Eagle Analytical Services Epson America, Inc. Essential Formulas Incorporated EXAKT Technologies, Inc. Eye

1 0 T H A N N U A L R X M I X E R P R E S E N T S :

B E N E F I T I N G T H E I A C P F O U N D A T I O N

SUNDAY, MAY 18 , 2014 ~ 6 :30PM – MIDNIGHT�Crystal Gateway Marriott, Grand Ballroom, Arlington, Va.

P R O S P E C T U S

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Why should you contribute to the IACPFoundation’s 10th Annual Rx Mixer?

Very simply, you are helping to ensure the future ofcompounding….

The IACP Foundation is a non-profit 501(c)(3) educationalfoundation and serves as the charitable extension of IACP with amission to fund research and educational initiatives to advancethe art and science of pharmacy compounding.

Each year, the IACP Foundation’s activities include:

• Funding innovative programs and research initiatives thatenhance the quality, safety, responsiveness, and credibility ofpharmacy compounding;

• Encouraging curricular endorsement of the fundamentalproficiencies essential to compounding pharmacists throughalliances with educational institutions and accreditationbodies; and

B E N E F I T I N G T H E I A C P F O U N D A T I O N

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SUNDAY, MAY 18 , 2014 ~ 6 :30PM – MIDNIGHT

• Sponsoring public education programs that aspire toacquaint health care professionals and the public with theservices and issues related to pharmacy compounding.

Your support and involvement is crucial in raising funds for theIACP Foundation so that we can continue the good work westarted more than 10 years ago.

Who attends the Rx Mixer?

The Rx Mixer is attended by top-leading compoundingpharmacists and technicians from across the country. Attendeesare the leaders in the compounding profession and the decisionmakers in the pharmacy. Attendees truly understand theimportance of the advancement of pharmacy compounding by supporting the Rx Mixer’s goal to raise funds for research and educational initiatives. We anticipate hosting more than 200 attendees in 2014.

YOU ARE INVITED to the 10th Annual Rx Mixer, The Roaring Twenties: The Compounding

Age, benefiting the IACP Foundation! The IACP Foundation is the only foundation established to benefit

pharmacy compounding. As we gather again with our colleagues and friends, we want to emphasize

that Rx Mixer is much more than a fun party. This event is one of the primary ways we have to fund a

vitally important mission – to support the quality, integrity, and advancement of pharmacy compounding

and its practitioners for the benefit of patients. We hope you will make it a commitment to join us at

this important event!

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Premium 2013 Rx Mixer sponsors included:

Past CCH exhibitors and sponsors have included:

Why you should participate in the Rx Mixer?

• This is a great opportunity to demonstrate that your company supports the future of pharmacycompounding.

• Unwind and visit with current and potential clientsand their families in a fun environment.

• Sponsoring a table is a great way to show yoursupport of the Rx Mixer. And what better way toentertain your clients than at a party with a purpose.

• Sponsors receive complimentary listings in all RxMixer event materials plus the IACP Rx Mixer website,the bi-weekly e-newsletter, Capitol Connections, theIACP Foundation e-newsletter and the Compounderson Capitol Hill e-newsletter.

• Additional recognition is provided with premium levelsponsorships.

• Premium level sponsors receive prominent signagethroughout the Rx Mixer event and during theCompounders on Capitol Hill meeting.

• Sponsors receive complimentary listings in the Rx Mixer Flipbook distributed to all IACP Membersprior to the meeting and in the printed editionsdistributed on-site at the Rx Mixer.

• Premium level sponsors receive complimentaryadvertisements in the Rx Mixer Flipbook and printedprogram editions, based on their level of commitment.The ad is provided by the sponsor and will linkdirectly to the company website designated by thesponsor. Additional discounted ads are available forpurchase as well.

• You will also receive a complimentary listing in the Rx Mixer post-event report distributed to all IACPMembers via the IACP Foundation e-newsletter and located on the Rx Mixer web page.

Fagron

Freedom Pharmaceuticals, Inc.

Humco Compounding

Letco Medical

MEDISCA

PCCA

Topi-Click Topical Dosing Applicator

A.P.I. Solutions, Inc.ATS LabsAirClean SystemsAir ScienceAir-Tite Products Co., Inc.American College of ApothecariesAnalytical Research LaboratoriesAssociates of Cape Cod, Inc.B&B Pharmaceuticals, Inc.bioMérieuxBiosRx, Inc.BIO-TECH Pharmacal, Inc.CPCSICharles RiverThe Compounders GroupDigi-Trax CorporationDYNALABSEMD MilliporeEagle Analytical ServicesEpson America, Inc.Essential Formulas IncorporatedEXAKT Technologies, Inc.Eye Solutions, Inc.FagronFreedom Pharmaceuticals, Inc.Health Engineering Systems

Great location for two great events – the Rx Mixer and CCHThe Rx Mixer will take place on Sunday, May 18 as a key component ofIACP’s Annual Compounders on Capitol Hill (CCH). In 2014, the Rx Mixerand the 20th Annual Compounders on Capitol Hill will be held at the CrystalGateway Marriott in Arlington, Va. Located only two miles from RonaldReagan National Airport (DCA), the Crystal Gateway Marriott offersimmediate lobby access to Washington D.C.’s world-famous Metro systemand a quick ride to all the museums, sights, restaurants, and even theCapital. It bringsattendees and exhibitorsmuch needed meetingspace, a larger exhibithall allowing for primebooth traffic, discountedparking to encouragelocal compounders’participation, and aconsiderably lower ratefor hotel rooms.

To learn more about the Crystal Gateway Marriott, click here or visithttp://www.marriott.com/hotels/travel/wasgw-crystal-gateway-marriott/

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SUNDAY, MAY 18 , 2014 ~ 6 :30PM – MIDNIGHT

Humco CompoundingInternational Journal of Pharmaceutical

CompoundingInternational Medical Industries, Inc.IsoTech DesignLetco MedicalLive Oak BankLife FileMar Cor PurificationMEDISCAMEDISCA NetworkMetagenicsNational Community Pharmacists AssociationPCCAPCCA – WorldwidePharmacy Compounding Accreditation BoardPharmacy Marketing QuarterlyRxCoop, LLCRXinsiderRx Skin TherapyStorey MarketingTeleManager TechnologiesTopi-Click Topical Dosing ApplicatorTorpac CapsulesUnited States PharmacopeiaVinco, Inc.ZRT Laboratory, LLC

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SUNDAY, MAY 18 , 2014 ~ 6 :30PM – MIDNIGHT 4

T-shirt Sponsor – $8,000Upscale logo-wear provided to all attendees. The t-shirt will beprovided on a table at Compounders on Capitol Hill with yourcompany’s logo displayed near the t-shirt table and included inall promotional materials. Additionally, this sponsorship includesone premium table of eight, $2,500 Casino Fun Bucks, 16 drinktickets, two complimentary bottles of wine, recognition from theMaster of Ceremonies during the event, and one full-color, half-page ad in event program. A special commemorative gift will beprovided to the sponsor.

Decorations Sponsor – $6,500 – SOLDTravel back to the Jazz Age when you enter the Rx Mixercelebrating The Roaring Twenties! The event will be adorned withthe glamour of the 1920s. A small item with your company’s logomay be provided for inclusion on the dinner tables. Additionally, thissponsorship includes one premium table of eight, $1,500 CasinoFun Bucks, 16 drink tickets, one complimentary bottle of wine,recognition from the Master of Ceremonies during the event, andone half-page, full-color ad in event program. A specialcommemorative gift will be provided to the sponsor.

Bar Sponsor – $6,500 – SOLDShake it up with a cocktail bar sponsorship! Always a frequent stop for attendees, this sponsorship will provide your company prominentexposure with a drop ceiling banner with your company logo placedabove two bar stations at the event. Additionally, this sponsorshipincludes one premium table of eight, $1,500 Casino Fun Bucks, 16 drink tickets, one complimentary bottle of wine, recognition from the Master of Ceremonies during the event, and one full-color, half-page ad in event program. A special commemorative gift will be provided to the sponsor.

Photo Booth Sponsor - $5,000 – SOLDA picture is worth a thousand words!This sponsorship is a great way to showyour company’s support of the Rx Mixerin a unique way! Always a focal point ofany party, this sponsorship will addsome memorable fun to the evening’sfestivities. A modern, free-standingdigital photo booth will be open to allattendees at the Rx Mixer from 6:30-10:30 p.m. As photo booth sponsor, yourcompany logo may be included with theRx Mixer logo on each instant photooutput at the event. Additionally, thissponsorship includes one premium table of eight, $1,500 CasinoFun Bucks, 16 drink tickets, one complimentary bottle of wine,recognition from the Master of Ceremonies during the event, andone half-page, full-color ad in event program. A specialcommemorative gift will be provided

PREMIUM SPONSOR OPPORTUNITIES

Auction Sponsor – $10,000 – SOLDThis sponsorship includes your company’slogo or branded message on auctionpaddles given to all attendees at the RxMixer and the exclusive title sponsorshipof the Rx Mixer Flipbook Program. As theRx Mixer Flipbook Program sponsor, yourcompany will receive twice the impact –print value and viral exposure! The program will include everythingattendees need to know about the Rx Mixer including auction itemdescriptions, program schedule and donor listings. The Rx Mixer FlipbookProgram will be distributed via a web link to all IACP Members in IACP’sCapitol Connections e-newsletter, the meeting e-newsletter, andprominently featured on the Rx Mixer web page. Your company willreceive one full-page color ad with prominent placement inside theprinted edition and in the electronic edition, which will link directly to your company web site. Additionally, this sponsorship includes onepremium table of eight, $2,500 Casino Fun Bucks, 16 drink tickets, two complimentary bottles of wine, recognition from the Master ofCeremonies during the event, one full-color, drop ceiling banner withcompany logo, and one full-color, full-page ad in the event program. A special commemorative gift will be provided to the sponsor.

Putting on the Ritz Entertainment Sponsor – $10,000 – SOLDBe the hit of the party! This unique entertainment sponsorship will‘literally’ demonstrate your company’s enthusiasm and passion forpharmacy compounding! We need your help to provide a dance floor,lighting and a music DJ. Your company’s logo will be projected in theballroom during the program. Your company will receive one full-pagecolor ad with prominent placement inside the Rx Mixer Programprinted edition and in the electronic Flipbook edition, which will linkdirectly to your company web site. Additionally, this sponsorship

includes one premium table ofeight, $2,500 Casino FunBucks, 16 drink tickets, twocomplimentary bottles of wine,recognition from the Master of

Ceremonies during the event, one full-color, drop ceiling banner withcompany logo and one full-color, full-page ad in event program. Aspecial commemorative gift will be provided to the sponsor.

Cotton Club Sponsor – $8,000 – SOLDWith your support, attendees can enjoy a lounge with seatingconducive to relaxed conversation with old and new friends. This areawill be located prominently in the event space and designated by afull-color, drop ceiling banner with your company’s logo. Additionally,this sponsorship includes one premium table of eight, $2,500 CasinoFun Bucks, 16 drink tickets, two complimentary bottles of wine,recognition from the Master of Ceremonies during the event, one full-color, drop ceiling banner with company logo and one full-color,full-page ad in event program. A special commemorative gift will beprovided to the sponsor.

BundleSponsorshipOpportunity!

UpgradedSponsor Benefits

Swingin’ & shufflin’, tappin’ & flappin’ your way around the dance floor!

Images used for illustration only.

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to the sponsor.CASINO SPONSORSHIPSRoulette Table Sponsor – $5,000 – SOLDJust spin the wheel and let the good times roll! This gaming table is one of the most popular tables at the Rx Mixer.Additionally, this sponsorship includes one premium table of eight, $1,500 Casino Fun Bucks, 16 drink tickets, onecomplimentary bottle of wine, recognition from the Master ofCeremonies during the event, one full-color, drop ceiling bannerwith company logo and one full-color, half-page ad in eventprogram. A special commemorative gift will be provided to thesponsor. The gaming tables are open to all ticketed guests.

Blackjack Table Sponsor – $3,000 (five available) This sponsorship includes one table of eight, $1,000 CasinoFun Bucks, 16 drink tickets, recognition from the Master ofCeremonies during the event, one full-color, drop ceiling bannerwith company logo and one full-color, quarter-page ad in eventprogram. The gaming tables are open to all ticketed guests.

Texas Hold ‘em Table Sponsor – $3,000 – SOLDThis sponsorship includes one table of eight, $1,500 CasinoFun Bucks, 16 drink tickets, one full-color, drop ceiling bannerwith company logo and one full-color, quarter-page ad in eventprogram. The gaming tables are open to all ticketed guests.

Craps Table Sponsor – $3,000 (one available)This sponsorship includes one table of eight, $1,000 Casino FunBucks, 16 drink tickets, one full-color, drop ceiling banner withcompany logo and one quarter-page, full-color ad in event program.The gaming tables are open to all ticketed guests.

Casino Fun Bucks Sponsor - $2,000 – SOLDYour company logo is the exclusive sponsor of the only casino playmoney at the event - Casino Fun Bucks. In order to play the casinogaming tables, a hugely popular aspect of the event, each attendee willhave to exchange this play money for chips. Your company’s logo will beprominently placed on the front of a minimum of 500 Casino Fun Bucksat the event. Additionally, this sponsorship includes one table of eight,$1,000 Casino Fun Bucks, 16 drink tickets, and one quarter-page, full-color ad in event program.

For additional event opportunities, please contact Meridyth Moore at (281) 933-8400.

TABLE SPONSORSHIPS – $1,750 (Table of eight)Join your state concierge or make it an event the entire staff can enjoytogether! This sponsorship includes one table of eight, $800 Casino FunBucks, 16 drink tickets, and one quarter-page, full-color ad in event program.

INDIVIDUAL TICKETS – $150 Access to the Rx Mixer, dinner buffet, two drink tickets and $100 Casino Fun Bucks. (No reserved seating)

In addition, all sponsors receive:

• Recognition in Rx Mixer materials and on-site signage.

• Acknowledgment on the Rx Mixer web page: www.iacprx.org

• Listing recognition on projection screen during event.

• Acknowledgment in all three IACP e-newsletters the bi-weekly e-newsletter, Capitol Connections, the IACP Foundation e-newsletter and the Compounders on Capitol Hill e-newsletter.

B E N E F I T I N G T H E I A C P F O U N D A T I O N

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A&O Specialty Pharmacy, Dave Smith, RPh, FIACPAcology Prescription Compounding, Mike Coppedge,

RPhActon Pharmacy Inc., Saad Dinno, RPh, FIACPAnderson Compounding Pharmacy, Cleve Anderson,

DPhAndrews Pharmacy, Jerry Beamer, RPhAnonymous DonorAnonymous DonorApothecary Options, Steve Edgar, RPhAsheville Compounding Pharmacy, John Boff, RPhBay Pharmacy Compounding, Gordon Punt, RPh, and

George Warren, RPhBearss Pharmacy, Adeleke Alli, RPhBert’s Pharmacy, Lee Berrettini, RPhBintz Pharmacy, Gary Bintz, RPhBoudreaux’s Specialty Compounding, Douglas

Boudreaux, PD, RPhBroadway Apothecary, Kate James, RPh, FIACP and

Willie JamesCarr Drugs, Randy Carr, RPh, FIACPCarroll Pharmacy, Greg Carroll, RPhCarrollwood Pharmacy, Dan Fucarino, RPhCentral Rexall Drugs, Donald Fellows, RPhClark Professional Pharmacy, Nathan Worthing, RPhCoast Compounding Pharmacy, Dieter Steinmetz, RPhColony Drug, Patty Johnson, RPhCommunity Clinical Pharmacy, Kris Kaniski, PharmDCommunity Pharmacy, Noel Carrico, RPhCompounding Care Pharmacy, Cathy Nance, RPhCooper Drugs, Robert Cecil, RPhCounty Square Pharmacy, Robert Heroux, RPhCrosby’s Drug, Inc., Fred MerchantCustomMed Apothecary, LLC, Jeff Jackson, RPhCustom Med Compounding Pharmacy, John Holland,

PharmDCustom Prescriptions of Lancaster, Diane Boomsma,

PharmD, FIACPCustom Scripts, James Castillo, RPhCyrus Kirkpatrick Pharmacy, Robert McClelland,

PharmDDaleo Compounding Pharmacy, Charles Daleo, RPhDanhauer Drug Store, Jeffrey Danhauer, RPhDavis Islands Pharmacy, Bob Bobo, RPhDistrict Drugs, Jim Perry, RPhEvans City Apothecary & Wellness Center, Jeff

Mustovic, RPhEvans Prescription Pharmacy, Bentley Hawley, RPhFairview Compounding Pharmacy, Gary Carlson, RPhFallon Pharmacy, Peter Fallon, RPhFamily Med Pharmacy, Carter Cobb, PharmDFry’s Prescription Pharmacy, Ben Fry, RPhGreenpark Pharmacy, Kenneth Hughes, RPhHalliday’s & Koivisto’s Pharmacy, Jim Koivisto, RPh Harvest Drug & Gift, Inc., Janet Beard, RPh, FIACPHealth Innovations Pharmacy, Timothy Clark, RPh

Healthway Compounding Pharmacy, Mike Collins,RPh, FIACP

Healthwise Pharmacy of Greenville, Inc., Gary Glisson,RPh, FIACP

Healthy Choice Apothecary, Phil Altman, RPhHeritage Compounding Pharmacy, Chris Burgess, RPhHieber’s Pharmacy, Joseph Bettinger, RPhHinkle’s Pharmacy, John Hinkle, RPhHome Care Pharmacy, Joseph Corgan, RPhHudako’s Pharmacy, Peter Halecky, RPhInnovative Pharmacy Services, Keith Guy, RPh, FIACPInnovative Pharmacy Solutions, Dave Mason, RPhJohn Hollis, Inc., John Hollis, RPhJones Pharmacy, Ralph Balchin, RPhKeystone Pharmacy, David J. Miller, RPh, FIACPKinsey’s Pharmacy, Robert Kinsey, RPhLadd Family Pharmacy, Elaine Ladd, PharmDLambert-Kipp Pharmacy, Doug Kipp, RPhLarry’s Pharmacy, Larry Hobbs, RPhLetco Medical, Brian CipperleyLiberty Drug & Surgical, Al Brown, RPhLloyd’s Pharmacy, Ron Johnson, RPhLoop Plaza Pharmacy, William McFarland, RPhMadison Drugs, Terry Wingo, RPhMagnolia Pharmacy, Steven Hoffart, PharmDMaryville Pharmacy, Gary Ceretto, RPhMcMahan Pharmacy, Mike McMahan, RPh, and

Haverde Warner, RPhMcMakin Pharmacy, Doug McMakin, RPhMedi Thrift Drugs, John Costanza, RPhMedic Pharmacy, Clay Moore, RPhMedical Center Pharmacy, Gerard Bouchard, RPhMedical Center Pharmacy, Henry Herring, RPhMedicine Man Pharmacy, Harry Melnick, RPhMedicine Shoppe, Terry ColeMedicine Shoppe Pharmacy, Wayne Wallace, RPhMillers of Wyckoff, David Miller, RPhMoose Drugs, Joe Moose, RPhMoses Lake Professional Pharmacy, Shawn

Needham, RPhMyers Drug, Doug Chadwick, RPhOakdell Pharmacy, Jeff Carson, RPhOsterhaus Pharmacy, Marilyn Osterhaus, BS PharmPark Pharmacy & Compounding Center, Dennis

Saadeh, RPhPear Tree Apothecary, Jenny Partridge, PharmDPharmacy Creations, Scott Karolchyk, MS, RPh, FIACPPioneer Health Compounding Pharmacy LLC, Ron

SylvainPCCA, Danyce AshtonPCCA, David CatalanoPCCA, Mike DeLisioPCCA, Lizzie DragonPCCA, Mark FellerPCCA, Lisa Johnson

PCCA, Adam KempPCCA, Erin MichaelPCCA, Debbie OwensPCCA, Ari PailakianPCCA, Michelle PerreaultPCCA, Deanna TaurielloPJ’s Prescription Shoppe, Mary Holgrave, RPhPoquoson Pharmacy, David Creecy, RPhPortage Pharmacy, Larry Curtis, RPhPotter’s House Apothecary, Crissy Borg & Kevin Borg,

PharmD, FIACPPremier Custom Pharmacy, Tracy Christian, RPhPremier Pharmacy Labs Inc., Vern Allen, RPhPrescription Alternatives, Inc., Janet Carter, RPhPrescription Compounds, Patsy Angelle, PD, FIACP,

FACAProfessional Building Pharmacy, Jung Lee, RPhRed River Pharmacy Services, David Boudreaux, RPhReliable Rexall Drug, Sam Ching, RPhRockwell Compounding, Steven Cosentino, RPhScriptWorks, Bob Brensel, RPhShare N Care Pharmacy, Wilfred Chavez, RPhSheefa Pharmacy & Wellness Center, Ashraf Latif,

RPhSierra Health Mart, David Vasenden, RPhSkrip Shoppe Compounding Pharmacy, James

Greene, RPhSmith’s Drug, John Higgins, RPhStephenson Pharmacy, Patrick Healy, RPhStewart’s Pharmacy & The Wellness Store, Lee

Stewart, RPhStone’s Pharmacy, Inc., Leigh McConchie, RPhTar Heel Drug, Inc., Jim Deming, PharmD, RPhThe Apothecary, Stephen Anderson, RPhThe Clinic Pharmacy, Tim Barrick, PharmDThe Medicine Shoppe, John Antony, BPharm,

MSc,PhDThe Medicine Shoppe, Barry Bilbro, RPhThe Medicine Shoppe, Gary Meyer, RPhThe Medicine Shoppe, David Pain, RPhThe Remedy Pharm, Nilesh Bhakta, RPh, PharmDThe Sullivan Pharmacy, Joan Jones, RPh and Tony

Jones, RPhTown & Country Compounding & Consultation, John

Herr, RPh, FIACPTriad Compounding Pharmacy, Ron Miller, RPhTriangle Compounding, Danny Barnes, PharmDTri State Compounding Pharmacy, John Dinkelaker,

RPhTwelve Corners Apothecary, William Winkowski, RPhUniversity Compounding Pharmacy, Joseph Grasela,

RPhVet Med, Inc., John DeMars, RPhVoshell’s Pharmacy, Jay Dorsch, RPhWayne’s Pharmacy, Wayne Ulrich, RPhWestern Iowa Compounding Solutions, Edward Maier,

RPh

THANK YOU to the following IndividualDonors for supporting Rx Mixer 2013!

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Your contribution to IACP Foundation is tax-deductible to the extent permitted by law. IACP Foundation is a 501(c)(3) non-profit, charitable organization. Tax I.D. #90-0064139. Incompliance with the Internal Revenue Service guidelines, all donations (minus fair market value) are tax-deductible. We estimate the fair market value of each ticket to be $120.00 perperson. The amount of your contribution that is deductible for federal income tax purposes is the difference between the cash donation given and the value of the benefits received.Please retain a copy for your tax records.

Company __________________________________________________________________________________________________________

Contact Name ____________________________________________________________________Title ________________________________

Address ____________________________________________________________________________________________________________

City ____________________________________ State__________________________________ Zip ________________________________

Phone __________________________________ E-mail ________________________________ Web Site ____________________________

PREMIUM SPONSORSHIP

____ $10,000 Auction Sponsor

____ $10,000 Putting on the RitzEntertainment Sponsor

____ $8,000 Cotton Club Sponsor

____ $8,000 T-shirt Sponsor

____ $6,500 Decorations Sponsor

____ $6,500 Bar Sponsor

____ $5,000 Photo Booth Sponsor

CASINO SPONSORSHIP

____ $5,000 Roulette Table Sponsor

____ $3,000 Blackjack Table Sponsor (five available)

____ $3,000 Texas Hold ‘em Table Sponsor

____ $3,000 Craps Table Sponsor (one available)

____ $2,000 Casino Fun Bucks Sponsor

TABLE SPONSORSHIP – $1,750 (TABLE OF EIGHT)_____________ # of Tables$ ____________ Table subtotal

INDIVIDUAL TICKETS – $150 _____________ # of TicketsTotal ticket amount

PAYMENT CALCULATION $ ____________ Sponsorship subtotal$ ____________ Cash Donation subtotal$ ____________ Table Sponsorship subtotal$ ____________ Ticket Sales subtotal$ ____________ Total Due IACP Foundation

Limited Availability: To reserve your spot, please mark (“X”) for the sponsorship(s) you desire.

q I/We cannot attend the Rx Mixer but would like to donate to the Auction. Please have an auction committee member give me a call! q I/We cannot attend the Rx Mixer but would like to support the IACP Foundation with a donation of $ ______________________.

PLEASE RESPOND BY February 1, 2014 IN ORDER TO MEET PRINT DEADLINES.

Payment

q Check (Please make payable to IACP Foundation.) q Credit Card (circle one): Discover VISA MasterCard AMEX

Credit Card Number_______________________________________Exp. Date ______________________V-code ___________________________

Card Holder’s Name____________________________________________________________________________________________________

Billing Address of Card _________________________________________________________________________________ (if different from above)

Authorized Signature ___________________________________________________________________________________________________

Person filling out this form (if different from above)_______________________________________________________________________________

Please mail or fax a copy to: IACP FoundationAttn: Rx Mixer4638 RiverstoneMissouri City, TX 77459

Phone: (281) 933-8400 Fax: (281) 495-0602E-mail: [email protected]

©2014 International Academy of Compounding Pharmacists (IACP). All rights reserved.

SPONSORSHIP AND AUCTION ITEM COMMITMENT FORM

__________________________________________________________________________________________________________________Please indicate how your name should appear on all sponsorship recognition.

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SOLDSOLD

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