One Day RegistrationPlease enable JavaScript in your browser to complete this form.Register before June 30, 2024 and save $50 for early bird pricing reflected below!Select Your Early Bird Registration TypeAAFP Member Licensed Practicing Physician – $725.00Non-member Licensed Practicing Physician – $900.00PhD – $725.00NP/PA/RN/PharmD – $550.00Retired Physician – $525.00Family Medicine Resident (Free) – $0.00Medical Student (Free) – $0.00Name *FirstLastDesignation *MDMDDONPPARNPharmDPhDResident PhysicianMedical StudentAAFP ID Number *7 digit numberAAFP ID Number7 digit numberLayoutEmail *EmailConfirm EmailPhone *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWould you like to sponsor a student?Yes, I do! – $75.00Your registration includes complimentary breakfast, lunch, and snacks all three days, plus one free adult dinner ticket for the special Thursday and Friday dinners. In an effort to reduce food waste, please select the appropriate responses below.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.Which days do you plan on joining us for breakfast? *ThursdayFridaySaturdayI will eat on my ownWhich days do you plan on joining us for lunch? *ThursdayFridaySaturdayI will eat on my ownWould you like free dinner tickets? *I will join on Thursday. Please reserve me a ticket.I will join on Friday. Please reserve me a ticket.I am unable to join, do not provide me with any tickets.Attend the Friday DinnerI will attend. Please provide me with a free meal ticket.I am not able to attend.Do you need to purchase additional dinner meal tickets for family members? Children 5 and under are free. *YesNoThursday Welcome Dinner – Adult $50012345678910Thursday Welcome Dinner – Child (6-12) $25012345678910Friday Awards Dinner – Adult $55012345678910Friday Awards Dinner – Child (6-12) $30012345678910Alternate Code Apply Total$0.00Square *CardName on CardContinue