www.hoparx.org

Member List Rentals

HOPA Mailing List Request Form
The cost to rent the HOPA member mailing list (per use) is $500. The list currently contains approximately 1,000 mailing addresses.
List Format:
Microsoft Excel format (additional formats available upon request; other charges may apply)
* - Indicates Required Field

Delivery Date:

Bill To:

First Name *

Last Name: *

Company: *

Address: *

City *

Country *

State *

Zip Code: *

Daytime Phone:

Fax:

E-Mail: *

Ship To (If different than Bill To:

First Name:

Last Name:

Company:

Address:

City:

Country:

State:

Zip Code:

Daytime Phone:

Fax:

E-Mail:

*Additional Directions: (indicate purpose for which this list will be used and include a sample mailing piece with order)

Direction

Attachment *

(Attachments must be jpg, gif, png, doc, or pdf)

Terms and Conditions:

I understand that the file that I will receive from the Hematology/Oncology
Pharmacy Association (HOPA) is the exclusive property of HOPA and can only be
used for the one-time use for which it was indicated above. This list cannot be
reproduced or distributed to any other parties without HOPA's written
permission and/or payment of an additional fee. Those attempting to reuse the
list will be charged a fine of $500 in addition to the list price of $500 for
every instance of misuse.

Accept * I accept the above Terms and Conditions.