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Prescription Drug
Discount Card Program
Please complete the below form to receive your prescription drug discount cards. Feel free to distribute to employees, family members and friends. The cards will be mailed to the address that is listed on the form. NOTE: If you are a CEDIA member, please click on the right side of the page.
Trade Association Membership (if applicable):
How many Prescription Drug Discount Cards do you need?
Number of cards to be mailed:
Contact Name:
Address:
Organization / Company (if applicable):
City:
State:
Zip Code:
Telephone:
Email Address:
Comments:
Do not enter anything in this field:
CEDIA Members Click Here
