Student Delegate Application – New Mexico Academy of Family Physicians

Ruidoso Seminar Attendee Registration Exhibitor Registration

Future Delegate Application

Are you a resident or student? *

Resident
Student

Name *

First

Last

ID do do

AAFP ID Number *

IDs issued in 2026 use 8 digits and all prior IDs use 7

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Email

Confirm Email

Why do you want to represent New Mexico at the national FUTURE Congress? *

What leadership experience do you have? *