Skip to main content
Skip to footer
Attendee Registration
Exhibitor Registration
Home
Conferences
65th Annual Family Medicine Seminar
Attendee Registration
Exhibitor Registration
Presentations Archive
Newsletter
About Us
Get Involved
Contact Us
Home
Conferences
65th Annual Family Medicine Seminar
Attendee Registration
Exhibitor Registration
Presentations Archive
Newsletter
About Us
Get Involved
Contact Us
Attendee Registration
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Layout
Designation
*
MD
MD
DO
NO
PA
RN
PharmD
PhD
Resident Physician
Medical Student
AAFP ID Number
Required for members, residents, and students
Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Registration Type
AAFP Member Licensed Practicing Physician $600
Non-member Licensed Practicing Physician $775
PhD $600
NP/PA/RN/PharmD $475
Retired Physician $390
Family Medicine Resident (No Charge)
Medical Student (No Charge)
Sponsor a Student Attendee
I want to sponsor a student attendee $75
Your registration includes one free adult dinner ticket for Thursday and Friday. If you do not plan on attending the dinner(s), please choose the appropriate response below to help us reduce food waste.
Attend the Thursday Dinner
*
I will attend. Please provide me with a free meal ticket.
I am not able to attend.
Attend the Friday Dinner
*
I will attend. Please provide me with a free meal ticket.
I am not able to attend.
Do you need to purchase additional meal tickets for family members? Children 5 and under are free.
*
Yes
No
Thursday Dinner - Adult $45
0
1
2
3
4
5
6
7
8
9
10
Thursday Dinner - Child (6-12) $25
0
1
2
3
4
5
6
7
8
9
10
Friday Awards Dinner & Dance - Adult $50
0
1
2
3
4
5
6
7
8
9
10
Friday Awards Dinner & Dance - Child (6-12) $30
0
1
2
3
4
5
6
7
8
9
10
Total
$ 0.00
Continue
