North Dakota Academy of Family Physicians
501 North Columbia Road, #2510
Grand Forks, ND 58203
(701) 777-3276

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: $450 $500
All other physicians, FNP's, PA's, RN's
and other Specialities		 $525 $575
Residents outside ND* $300 $350
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
# Attending
Adults - Children		 Meals and Special Events: Please only list additional guests that will be joining you.
- Tuesday Late Afternoon Family Movie
- Thursday Evening Dinner ($10 for each additional adult, $5 for each child (age 5-15).
Accepting Visa and MasterCard at this time.
Be sure to use the credit card blling address on the following page.