Walgreens Registration


	Walgreens Registration

jordansnonna

5-14-2008 3:41 PM

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<div style="margin: 12px 0px; font-family: arial; color: #333333; background: #ffffff; border: solid 4px #e5e5e5; width: 100%; clear: left;"><div class="CM_CTB_Content_Wrap" style="margin: 0px; padding: 0px;background-color: #ffffff;"><div style="border-bottom: solid 1px #dcdcdc; white-space: nowrap; margin-bottom: 8px; background-color: #eeeeee ;background-image: url(http://clipmarks.com/images/source-bg.gif); background-repeat: repeat-x; height: 24px; line-height: 24px; vertical-align: middle; padding-bottom: 4px; color: #666666; font-size: 10px;" ><a href="http://clipmarks.com/clip-to-blog/" title="see clips that are hot right now"><img src="http://content.clipmarks.com/blog_embed/99247965-e5d9-4302-ac70-5a58dc5020b7/D8BB2009-90B2-408F-9143-7A0B1DEC646A/" alt="" width="19" height="19" border="0" style="vertical-align: middle; margin: 0px 4px; display: inline; border: none; float:none;" /></a>clipped from <a title="https://www.walgreens.com/pharmacy/register/qr/rxfinal.jsp?_requestid=98169" href="https://www.walgreens.com/pharmacy/register/qr/rxfinal.jsp?_requestid=98169" style="font-size: 11px;">www.walgreens.com</a></div><blockquote style="text-align: left; padding: 0px 8px; margin: 4px 0px 8px 0px; background: transparent; border: none;" cite="https://www.walgreens.com/pharmacy/register/qr/rxfinal.jsp?_requestid=98169"><table background="undefined" bgcolor=""><tr><TD width="100%" valign="top"><FORM method="post" action="https://www.walgreens.com/pharmacy/register/qr/rxfinal.jsp?_DARGS=/pharmacy/register/qr/rxfinal_fg.jsp" name="loginform"><INPUT type="hidden" value="ASCII" name="_dyncharset" />
<TABLE><TBODY><TR><TD colspan="2" class="heading1">Review and Confirm Your Registration </TD></TR><TR><TD colspan="2" class="bodytext">If necessary, you may edit your information by selecting Edit Personal Information. Your registration will be complete once you click Confirm.</TD></TR><TR><TD><BR /></TD></TR></TBODY></TABLE><INPUT type="hidden" name="formVersion" value="51574" />
<INPUT type="hidden" value="/pharmacy/register/qr/rxfinal_fg.jsp" name="_DARGS" /><TABLE width="100%" cellspacing="0" cellpadding="0" border="0"><TBODY><TR class="highlight1"><TD class="heading3" colspan="2">Personal Information
					<BR /></TD></TR><TR><TD><BR /></TD></TR><TR><TD nowrap="" class="bodytext"><A href="https://www.walgreens.com/pharmacy/register/qr/rxupdateinfo.jsp?loc=/pharmacy/register/qr/rxfinal.jsp"><IMG width="12" hspace="4" height="12" border="0" alt="*" src="https://a248.e.akamai.net/7/248/5412/home/www.walgreens.com/images/bullet.gif" />Edit Personal Information</A></TD><TD align="right"><INPUT type="image" border="0" src="https://www.walgreens.com/images/buttons/new_confirm_button.gif" value=" " name="Confirm" /><INPUT type="hidden" value=" " name="_D:Confirm" /><INPUT type="hidden" border="0" value="" name="/atg/userprofiling/ProfileFormHandler.rxSetAccept" /><INPUT type="hidden" value=" " name="_D:/atg/userprofiling/ProfileFormHandler.rxSetAccept" /></TD></TR><TR><TD><BR /></TD></TR><TR><TD width="35%" align="right" class="bodytextbold">Customer Name:</TD><TD class="bodytext">BARBARA    YOUNKINS</TD></TR><TR><TD><BR /></TD></TR><TR><TD align="right" class="bodytextbold">User Name: </TD><TD class="bodytext">BarbaraYounkins</TD></TR><TR><TD><BR /></TD></TR><TR><TD align="right" class="bodytextbold">Gender: </TD><TD class="bodytext">Female</TD></TR><TR><TD><BR /></TD></TR><TR><TD align="right" class="bodytextbold">Date of Birth: </TD><TD class="bodytext">04/19/1944</TD></TR><TR><TD><BR /></TD></TR><TR><TD align="right" class="bodytextbold">E-mail Address: </TD><TD class="bodytext">solivitabee@hotmail.com</TD></TR><TR><TD><BR /></TD></TR><TR><TD valign="top" align="right" class="bodytextbold">Address: </TD><TD class="bodytext">326 DAVINCI PASS<BR />POINCIANA, FL 34759</TD></TR><TR><TD><BR /></TD></TR><TR><TD align="right" class="bodytextbold">Home Phone: </TD><TD class="bodytext">(863)  427-4040</TD></TR><TR><TD><BR /></TD></TR><TR><TD align="right" class="bodytextbold">Other Phone: </TD><TD class="bodytext">() </TD></TR><TR><TD><BR /></TD></TR><TR><TD align="right" colspan="2"><INPUT type="image" border="0" src="https://www.walgreens.com/images/buttons/new_confirm_button.gif" value=" " name="Confirm" /><INPUT type="hidden" value=" " name="_D:Confirm" /><INPUT type="hidden" border="0" value="" name="/atg/userprofiling/ProfileFormHandler.rxSetAccept" /><INPUT type="hidden" value=" " name="_D:/atg/userprofiling/ProfileFormHandler.rxSetAccept" /></TD></TR></TBODY></TABLE></FORM></TD></tr></table></blockquote></div><div style="margin: 0px 6px 6px 4px;"><table style="font-size: 11px;border-spacing: 0px;padding: 0px;" cellpadding="0" cellspacing="0" width="100%"><tr><td style="background:transparent;border-width:0px;padding:0px;">&nbsp;</td><td align="right" style="background:transparent;border-width:0px;padding:0px;width:107px" width="107"><a href="http://clipmarks.com/share/D8BB2009-90B2-408F-9143-7A0B1DEC646A/blog/" title="blog or email this clip"><img src="http://content8.clipmarks.com/images/c2b-foot.png" border="0" alt="blog it" width="107" height="17" style="border-width:0px;padding:0px;margin:0px;" /></a></td></tr></table></div></div>

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