Complete this form to request a tailored BPS presentation for students, residents, employees, or other interested parties. You may also request outreach from a BPS representative.

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Your name (Required.)

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Please provide brief background on the intended purpose and audience of the presentation, meeting, or conference. (Required.)

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Describe any specific interests of this audience (e.g. state-specific, specialty-specific).

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Your title (e.g. pharmacist, student, faculty member, organization president, committee member) and affiliation (e.g. college of pharmacy, pharmacy association, employer group). (Required.)

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Provide the date(s) and time of the presentation, meeting, or conference (if known).

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Are you requesting attendance of a BPS representative (staff or leadership)? (Required.)

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How did you hear about the toolkit and/or Request a BPS Presentation link? (optional)

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