Annual Meeting Registration Form 2024 Annual Scientific Assembly Registration 2024 Name (As you would like it to appear on badge) First Last Check Applicable MD DO Fellow NP Registrant T Shirt Size (Adult Sizes)SmallMediumLargeXL2XL3XLAAFP Member # Cell PhoneEmail(Required) Clinic or Organization Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code While in Destin, I will be staying:On Sandestin property, using MAFP Group Rates.On Sandestin property, but not group rates.Off property.Registration Type (Before July 1) MAFP Active Member ($489.25) MAFP Life Member ($386.25) Non-MAFP Member ($592.25) Family Medicine Resident ($0) Medical Student ($0) July 1stGuest/Spouse Quantity Price: $206.00 Quantity Guest registration is $200 for adults or children 18 and over. Includes admission to Exhibit Hall, Family Fun Night, Devotional, Yoga, Awards Luncheon, Bingo, Convention Tshirt.Guest Names, TShirt Size (Adult S – 3XL)Children’s Names and AgesBracelets will be given at regis, please wear to eventsPlease list any physical, dietary restrictions, or food allergies that you or any of your guests have:Additional ItemsSunday, July 21MEMBER – KSA: Care of Children (1 – 5p) Quantity Price: $128.75 Quantity NON-MEMBER – KSA: Care of Children (1 – 5p) Quantity Price: $257.50 Quantity MAFP Family Fun Night – (6 – 7:30p) Quantity Price: $0.00 Quantity Included with RegistrationMonday, July 22Spouse Bingo – 10a Quantity Price: $0.00 Quantity Included with Registration. Kids are welcome but will receive kids prize. Golf Tournament at The Raven – (2p) Quantity Price: $133.90 Quantity Shotgun startFoursome: Family Crab Hunt (Evening) Quantity Price: $0.00 Quantity Included with RegistrationTuesday, July 23MAFP Awards Lunch (Members Only) – 12:30p Quantity Price: $0.00 Quantity Included with RegistrationMAFP Awards Lunch EXTRA Tickets – 12:30p Quantity Price: $51.50 Quantity MAFP Split the Pot Drawing Quantity Price: $103.00 Quantity If I win, please donate this amount to the Foundation Enter amount you’d like donated to the foundationEXTRA ITEMS: The items below will be waiting for you at the Registration Desk.Diamond Club Quantity Price: $77.25 Quantity MAFP members are invited to donate $75 to the MAFP Foundation to celebrate 75 years. It takes a minimum of $75 to join the Diamond Club, and donations in multiples of $75 may be given. All donations will benefit MAFP Foundations scholarship and educational programs.Sponsor a Student/Resident Quantity Price: $51.50 Quantity Your contribution will directly help offset the cost of medical students and residents’ rooms & convention expenses. You will receive a Student Supporter ribbon.Water Color Paint Quantity Price: $51.50 Quantity 12 x 15 Family Medicine print, signed and numbered by artist Katie Erickson. (Special price for Annual Meeting attendees only.)Images Book Quantity Price: $51.50 Quantity Images in MS Medicine book by family physician Dr. Luke LamptonExtra Small (2-4) Quantity Price: $20.60 Quantity Small (6-8) Quantity Price: $20.60 Quantity Medium (10-12) Quantity Price: $20.60 Quantity Large (12-14) Quantity Price: $20.60 Quantity Adult (S) Quantity Price: $20.00 Quantity Adult (M) Quantity Price: $20.60 Quantity Adult (L) Quantity Price: $20.60 Quantity Adult (XL) Quantity Price: $20.60 Quantity Adult (2XL) Quantity Price: $20.60 Quantity Adult (3XL) Quantity Price: $20.60 Quantity Total Credit CardCard Details Cardholder Name Please note that a 3% credit card processing fee has been added to this transaction. Children 18 Years or Older: Children 18 years or older who plan to attend any functions listed on this form must pay the Guest registration fee. Cancellation Policy: In the event your registration must be cancelled, your fee (less $75) will be refunded if we are notified by June 25. No refunds will be made after June 25. NO REGISTRATIONS OR ACTIVITIES MAY BE CANCELLED AFTER ARRIVING AT CONVENTION. Attendee list will include those who have registered by July 7, 2024. T-shirt size requests will be taken until June 10. After that, your size availability is NOT guaranteed. Δ
