THE RX CLUB SHOW ENTRY FORM
	REGISTRATION ENTRIES FILE MANAGER PAYMENT SUBMISSIONS

	LOG-IN HERE if you have already registered and would like to edit or add additional entries. Agencies who have entered in the past two years can log-in here. REGISTRATION - please complete the form below to register and begin entering your RX Club entries. For future edits or additions please use your username and the password you have created here.
	AGENCY/COMPANY (your username will be created from your agency name)
	CONTACT PERSON		TITLE
	ADDRESS
	CITY		STATE	POSTAL CODE	COUNTRY
					Select country United States Argentina Australia Austria Belgium Brazil Bulgaria Canada Chile China Cocos (Keeling) Islands Colombia Costa Rica Croatia Czech Republic Denmark Estonia Finland France Germany Greece Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Japan Korea, Republic Of Latvia Lithuania Luxembourg Malaysia Mexico Micronesia Netherlands New Zealand Niue Islands Norway Peru Philippines Poland Portugal Romania Russian Federation Singapore South Africa Slovakia Slovenia Spain Sweden Switzerland Taiwan Thailand Turkey Tuvalu Venezuela United Kingdom Other
	E-MAIL		PHONE	FAX
	AGENCY WEB SITE
	http://
	PASSWORD (create your password for accessing your account)
	RE-TYPE PASSWORD
	If you have any problems please contact us at support@therxclub.com.