Instructions: If you would like to offer your own personal endorsement or your organization's endorsement of the proposal for a national unused drug disposal program, please submit your information in the form below.

Click here to review the proposal and current endorsements

 

Please indicate your support for this proposal by filling out the fields below and press "submit"

NAME
TITLE
ORGANIZATION
MAILING ADDRESS 1
MAILING ADDRESS 2
CITY
STATE
ZIP
PHONE
FAX
EMAIL
   
CHECK BOXES PLEASE CHECK ONE:
YES-On behalf of my organization, I endorse and support the proposal for a national unused drug return program and its submission to the recipients listed within the proposal. Please add my name, title and organization to the proposal.
   
YES- I would like to offer my personal endorsement of this proposal on my own behalf.
   
NO- I cannot support this proposal as written.
   
COMMENTS:  

 

 

Maine Benzodiazepine Study Group Logo

Maine Benzodiazepine Study Group

University of Maine Center on Aging

Camden Hall

25 Texas Avenue

Bangor, Maine 04401-4324

Phone: 1 (207) 262-7920

Fax: 1 (207) 262-7921

Email: mbsg@mainebenzo.org