77th Annual Assembly & Exhibition Registration (Attendee Registration) Registration

PLEASE NOTE: The following is the individual registration for physicians, staff and their guests for the 77th Annual Assembly & Exhibition.

Contact Information

First Name *

Last Name *

Designation

Mailing Address *

Address 2

City *

State *

Zip *

Phone *

Cell Phone

Email *

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Membership Information

AAFP ID#

Member of LAFP? *

Type of Member *

Specialty

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Event Attendance

Please select which functions below that you will be attending. If doubtful, please leave blank. This will aid LAFP in receiving an accurate count for meals and social events. These events are included in full registrations, however RSVP is required. Additional tickets may be purchased below. PLEASE NOTE: Daily registrations include CME and breaks with exhibitors only. Tickets required for social events!

Thursday, July 25, 2024

Friday, July 26, 2024

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

Breakfast with Exhibitors

Refreshment Break

General Assembly (LAFP Members only)

Awards and Installation Ceremony

President's Party and Foundation Fundraiser

Sunday, July 28, 2024

Breakfast Symposium (In-person attendee)

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

PLEASE NOTE: Daily registration fees include virtual and in-person attendance. If you are attending in-person the daily rate includes CME and breaks with exhibitors only. Tickets required for social events! Full on-site registrations include all events.

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Guest Registration

Guest registration is $80 for adult or child. Includes admission into the Welcome Reception, Awards & Installation Ceremony and President's Party/Foundation Fundraiser. Must accompany attendee registration.

Number of Guest(s)

Guest 1

Adult or Child? *

First Name *

Last Name *

Guest 2

Adult or Child? *

First Name *

Last Name *

Guest 3

Adult or Child? *

First Name *

Last Name *

Guest 4

Adult or Child? *

First Name *

Last Name *

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Additional Options

Sponsorship of student's attendance at Assembly ($75 each)

Foundation Golf Tournament (Thursday, July 25)

Golfer(s) Names *

Golfer(s) Shirt Size(s) *

President's Party/Foundation Fundraiser (Friday, July 26)--for guests & daily regis

Names

Awards and Installation Ceremony--(Friday, July 26)--for guests & daily regis

Names *

Donation to LAFP Foundation (number only)

Donation attributed to

T-Shirt Size *

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How did you hear about this meeting?

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Please list any special dietary restrictions.

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If you have any questions or comments, please contact the LAFP office at (225) 923-3313 or e-mail info@lafp.org.

CANCELLATION POLICY: Refunds, less a $100 administrative fee will be issued upon written request until April 20, 2023. You may cancel your room with a full refund if cancelled 7 days in advance of stay.

Payment Method

Please select method of payment: *

Pay by Check

Credit/Debit Card

Card Holder Name

Credit Card Number

Expiration Date

Card (CVV) Code

Billing Zip Code

Payment Information

Amount

Payment Method

Selected Above

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Registration

Contact Information

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Membership Information

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Event Attendance

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Guest Registration

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Additional Options

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Payment Method

Payment Information

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