Is your school interested in stocking neffy^® in case of emergency? Please fill out this form and we’ll be in touch.

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First Name *

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School information

School Name *

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Province *AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

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Order details

Number of Students Enrolled *0-4950-99100-199200-499500-999+1000

Preferred Delivery Date

I agree to be contacted by ALK regarding my order and other neffy^® information. I understand I may withdraw my consent at any time. *

^{* Required. By submitting this form, you confirm that you are authorized to discuss stocking epinephrine matters on behalf of your school.}

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