Manrex Limited - First Time Registrants

Welcome to Manrex Members Registration. This section of Manrex.com is a service reserved exclusively for full support customers. To register for this service, please complete the registration form below.

* - Indicates required fields.

*Business/Facility Name:
Customer Number:
* First Name:
*Last Name:
*Position (Title):
*Address:
*City:
*Province:
*Postal Code:
*Telephone:	( ) -
*Fax:	( ) -
*E-mail Address:

Dear Health Care Professional: Please enter the name of the Pharmacy that provides Pharmacy services to your long-term care facility.

Pharmacy System Provider:

*Username:
*Select Password:
*Verify Password:

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