Illinois Council of Health-System Pharmacists

* Member Only Content
** Board, Division and Committee Members only

Best Practice - Application Form

Please complete all fields required for applicant information. Please note the size restrictions for manuscript file uploads at the end of this form.

Best Practice Application 2012

	Name:
	ICHP ID Number:
	Email Address:
	Title/Position:
	Health-System Name:
	Address:
	City:
	State:
	Zip:
	Phone Number:
	Fax Number:
	Manuscript Title:
	List of Co-applicants (maximum of six):
	The manuscript will be forwarded to a pre-defined set of reviewers. Please do not include the names of the authors or affiliations in the manuscript to preserve anonymity.
	File to upload: File size must not exceed 20MB
	File to upload: File size must not exceed 20MB
	File to upload: File size must not exceed 20MB

If you have more than three files to upload, please forward via email to members@ichpnet.org. Include Best Practice Submission in the subject line and your manuscript title in the body of the email.

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