2023 IAFP Annual Convention Registration Question Title * 1. AAFP ID Question Title * 2. Full Name Question Title * 3. Nickname for Badge Question Title * 4. Designation (Select all that apply) MD DO Residency graduate in 2020, 2021, 2022, or 2023 Current Resident Current Student Other (please specify) Question Title * 5. Are you a Fellow of the AAFP (FAAFP)? Yes No Question Title * 6. City, State Question Title * 7. Phone Number Question Title * 8. Email Question Title * 9. I will be present for the following Thursday Morning CME Friday Breakfast Friday Congress of Delegates Lunch Friday Night Reception Saturday Congress of Delegates Lunch Question Title * 10. A guest will be joining me for the Friday Night Reception Yes No Question Title * 11. Thursday KSA Selection (included in full-conference and Thursday only registration prices) I will attend Thursday's CONCURRENT KSA Study Group on Care of Hospitalized Patients I will attend Thursday's CONCURRENT KSA Study Group on Asthma I will not participate in any KSA Study Sessions on Thursday Question Title * 12. Sunday KSA Selection (included in full-conference and Sunday only registration prices) I will attend Sunday's CONCURRENT KSA Study Group on Palliative Care I will attend Sunday's CONCURRENT KSA Study Group on Care of Women I will not participate in any KSA Study Sessions on Sunday Question Title * 13. Syllabus Choice I will download the free online syllabus (available one week before the meeting) I will purchase a printed syllabus for $50 (Please order in advance when completing your registration on our Square Store. We will NOT have additional copies for sale onsite.) Question Title * 14. Please list the first and last name(s) of any guests joining you for the Friday night reception or Trivia Night on Saturday: Question Title * 15. Your Full Conference Registration fee includes up to four tickets for Trivia Night on Saturday. Included tickets may be used for adults or children. Additional tickets may be purchased at our Square Store. Please indicate below how many tickets (total) you will use. 0 1 2 3 4 5 6 7 8 9 10 Question Title * 16. I am planning the following hotel accommodations I plan to stay at the French Lick Hotel I plan to stay at the West Baden Hotel I plan to stay at another hotel I do not plan to make hotel accommodations Question Title * 17. Special Needs Lactation Room Vegan Vegetarian Gluten Free None Question Title * 18. CONSENT TO USE OF PHOTOGRAPHIC IMAGES: Registration and attendance at, or participation in, IAFP meetings and other activities constitutes an agreement by the registrant for IAFP use and distribution (both now and in the future) of the registrant or attendee’s image or voice in photographs, videotapes, electronic reproductions, and audiotapes of such events and activities. Yes, I consent to use of photographic images No, I do not consent to use of photographic images Question Title * 19. CANCELLATION POLICY: You may cancel without penalty if cancellation request is received up to one week prior to the start of the conference. Due to financial obligations incurred by the IAFP, refunds or credits may not be issued for cancellation requests received less than one week prior to the start of the event. I agree to the cancellation policy Done