Spring Conference 2025 Registration Form Spring Conference 2025 Registration With Online Payment This form is for those who wish to pay online. If you want to register now and send in payment, please complete the other form below.Registrant Name(Required) First Last Please Choose One:(Required) MD DO NP Other Clinic NamePlease help us update our database by providing your clinic name. If you work for a hospital system, please indicate that as well. Please click the box below if you are an AAFP Fellow with the designation 'FAAFP': FAAFP Please click the box below if you are a first-time attendee: First Time Attendee Please click the box below if you request vegetarian meals at the conference. Vegetarian Please Please list any food allergies you may have: AAFP Member Number: Address:(Required) Street Address City State / Province / Region ZIP / Postal Code Mobile Phone:(Required)MAFP use onlyYour Email:(Required) Back by popular demand are our Round Table Discussions. Please indicate below if you would like to lead one or drop any discussion topics you would be interested in seeing: REGISTRATION FEES:Registration Fee(Required)The fees below reflect a 3% charge to offset processing fees. Cancellation Policy: Refunds, minus a $50 cancellation fee, will be made upon request in writing to the MAFP office, if received by April 1. After April 1, no refunds will be granted. MAFP Member – $412.00 NON Member – $489.25 While at the conference, I will be staying overnight at:(Required) Sheraton Refuge Off Property Are you interested in joining the Friday night dine arounds? If yes, please select which one. Eslava Amore Italian Restaurant Table 100 Sponsor a Student QuantityPromote family medicine interest by helping Mississippi medical students attend the 2025 Spring Fling. Your contribution will directly help offset the cost of medical students’ hotel rooms and conference expenses. You will be recognized with a special STUDENT SUPPORTER ribbon. Price: $51.50 Quantity MAFP LOGO ITEMSItems you order here will be waiting for you at the registration desk.MAFP Crew-Neck Sweatshirt – $30.90 each Quantity‘MAFP’ in big letters with ‘Mississippi Academy of Family Physicians’ written underneath. Text is navy on the white and grey items and white on the navy blue items. Price: $30.90 Quantity Sweatshirt Size & Color100% cotton crew-neck sweatshirt available in white, grey and navy blue. Sizes range from Adult Small to 3XL. Please specify your size and color preference here. MAFP T-shirt – $18.54 each Quantity‘MAFP’ in big letters with ‘Mississippi Academy of Family Physicians’ written underneath. Text is navy on the white and grey items and white on the navy blue items. Price: $18.54 Quantity T-shirt Size & Color100% cotton Gildan crew-neck t-shirt available in white, grey and navy blue. Sizes range from Adult Small to 3XL. Please specify your size and color preference here. MAFP FOUNDATION FUND RAISER ITEMSPurchase your items here , and they will be waiting for you at the Registration Desk!Watercolor Print (Signed & Numbered) Quantity(Special price for Conference attendees) Price: $51.50 Quantity Split the Pot Ticket Drawing QuantityDrawing to be held during the 2025 MAFP Annual Meeting in July. Tickets may be purchased during the Spring Conference. Price: $103.00 Quantity Images in Mississippi Medicine Book Quantity Price: $51.50 Quantity Total PAYMENTGroup CodeIf you have a group code, enter that here. Credit CardCard Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged. Δ
