Addendum Expression of Interest Form

This form is intended for Pharmacy Manager(s) or Owner(s) to fill out if they are adding additional pharmacists to their original Expression of Interest for the Pharmacists Manitoba Smoking Cessation Social Impact Bond (Quit Smoking with your Manitoba Pharmacist Program).

If you are a Pharmacy Manager or Owner and HAVE NOT submitted your initial expression of interest, please do so here: https://www.pharmacistsmb.ca/sib/expression-of-interest.html. This form is only intended for pharmacies who have already submitted their EOI and are looking to add additional pharmacists.

Please fill out the Addendum Expression of Interest Form Here!
Email info@pharmacistsmb.ca when you have completed the form.

If you have any questions about any of the fields or have trouble accessing the form, please contact Pharmacists Manitoba at info@pharmacistsmb.ca.