Please provide the following information to become a member of the Pfizer Plus online community. This information will be kept confidential and will not be shared without your consent.
(All information requested is required.)
Title: |
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First Name: |
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Last Name: |
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Primary Phone Number: |
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E-mail Address: |
(this is also your username)
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Confirm E-mail Address: |
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Date of Retirement: |
Month
Day
Year
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Legacy Company Retired From: |
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Site of Retirement: |
If your retirement location is not listed, please
select "Other". Then, contact us via the feedback form to let us know your
location.
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Street Address 1: |
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Street Address 2: |
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City of Residence: |
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State of Residence: |
If you reside outside the U.S., select "(outside US)". Then, enter your Province/Region in the field below.
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Province/Region: |
(for addresses outside US only)
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Postal Code: |
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Country of Residence: |
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