North Dakota Academy of Family Physicians

Click Here for the mail in form.

Big Sky Family Medicine Update - Registration Form

AAFP ID# (if applicable):
Name:
Title:
Address:
City, State, Zip:
Phone:
E-mail:
# Adults Attending:
# Children Attending:

	Before Dec. 1	After Dec. 1
North Dakota AFP Members:	$500	$550
All other physicians, FNP's, PA's, RN's and other Specialities	$575	$625
Residents outside ND*	$350	$400
North Dakota Residents & All Medical Students**	N/C	N/C
* - Out of State Residents please send a letter from the program director to verify your enrollment ** - ND Residents and Medical Students please register to assure accurate counts

Meals and Special Events
Please note if you and guest/children will be attending any of these events.

Tuesday Late Afternoon Movie

How many additional adults will be joining you at the movie?

How many additional children will be joining you at the movie?

Wednesday Evening Dinner

Check here if you, the attendee, will be going to the dinner

How many additional adults will be joining you? ($20 for each additional adult)

How many additional children will be joining you? ($10 for each child (age 5-15))

Accepting Visa, MasterCard, Discover and American Express at this time.
Be sure to use the credit card blling address on the following page.

Privacy Policy:

The North Dakota Academy of Family Physicians (NDAFP) will contact you regarding conference registration, details, and specific conference offers via the phone number and/or email address you provide during registration.

The NDAFP will not distribute your personal information for promotion or unsolicited purposes.

Cancellation Policy:

Registration Cancellations requested in excess of 30 days of the event will be subject to a $75 administrative fee. After that date no refunds will be given. Conference organizers cannot be responsible for travel difficulty due to road or weather conditions.