Fall Intensive: Informed Opioid Prescribing Fall Intensive: Informed Opioid Prescribing Name (As you would like it to appear on badge) First Last Check Applicable MD DO Fellow NP AAFP Member # Cell PhoneEmail(Required) Clinic or Organization Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Registration Fees MAFP Active Member ($250) Non-MAFP Member ($300) I am eligible to take the KSA Pain Medicine. Yes No Total Credit CardCard Details Cardholder Name Δ
