Annual Conference Registration TNAFP Annual Conference Registration "*" indicates required fields Name* First Last Designation*MDMD (resident)DODO (resident)Medical studentPANPOther healthcare providerNon healthcare providerPhone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dietary restrictions, including for any guestsSelect Registration*TNAFP/AAFP member ($600)Nonmember physicians, NPs, PAs, or other healthcare professionals ($700)Life member ($250)Guests ($175)Residents and medical students ($60)Single Day Pass - TNAFP/AAFP Member ($350)Single Day Pass - All Others ($450)2-hour prescribing course only (Sat, Oct. 25) ($75)LARC training and Nexplanon certification only ($150)KSA only ($150)President's Banquet (use below for how many)optional add-ons:Students and Residents only: Will you be attending the student track activities? Lunch with AAFP dignitary Introduction to Musculoskeletal Ultrasound Dermoscopy Workshop LARC training and Nexplanon certification – Wednesday, October 22 ($150) Quantity Price: $150.00 Quantity President’s Banquet – Thursday, October 23 - Adults ($60/ea) Quantity Price: $60.00 Quantity President’s Banquet – Thursday, October 23 - Children ($10/ea) Quantity Price: $10.00 Quantity Optional KSA – Pain Management – Saturday, October 25 ($150) Quantity Price: $150.00 Quantity Select number of guests (adults 18 or older) not participating in CME sessions but joining for meals - ($175/ea)* Quantity Price: $175.00 Quantity Total Credit CardCard Details Cardholder Name