79th Annual Assembly & Exhibition Registration (Attendee Registration)

First Name *

Last Name *

Designation

Mailing Address *

Address 2

City *

State *

Zip *

Phone Number: *

Cell Phone Number: *

Email Address: *

Member of LAFP? *

Yes

No

Type of Member *

AAFP ID# *

Specialty

Please select full OR daily registration(s) *

Thursday, July 23, 2026

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

Breakfast with Exhibitors

Refreshment Break

Lunch with Exhibitors

Welcome Reception (7 pm - 9 pm) *RSVP req'd

Friday, July 24, 2026

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

Breakfast with Exhibitors

Refreshment Break

General Assembly (LAFP Members only)

Awards and Installation Ceremony

FM Celebration and Foundation Fundraiser

Saturday, July 25, 2026

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

Breakfast with Exhibitors

Residency Program Directors Meeting (Residency Directors ONLY)

Refreshment Break

Lunch

Sunday, July 26, 2026

Breakfast Symposium (In-person attendee)

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

Number of Guest(s)

Adult or Child? *

First Name *

Last Name *

Adult or Child? *

First Name *

Last Name *

Adult or Child? *

First Name *

Last Name *

Adult or Child? *

First Name *

Last Name *

Student Sponsorship

Foundation Golf Tournament (Thursday, July 23)

Golfer(s) Names *

Golfer(s) Shirt Size(s) *

FM Celebration/Foundation Fundraiser (Friday, July 24)--for guests & daily registrations

Names

Awards and Installation Ceremony--(Friday, July 24)--for guests & daily registration

Names *

Donation to LAFP Foundation (number only)

Donation attributed to

T-Shirt Size *

How did you hear about this meeting? (select all that apply)

Weekly Newsletter

LAFP website

LA Family Doctor Journal

Mailing

Social Media

Other

Please list any special dietary restrictions.

Please select method of payment: *

Pay by Check

Credit/Debit Card

Amount

$

Payment Method

Selected Above

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Card Holder Name

Credit Card Number

Expiration Date

Card (CVV) Code

Billing Zip Code

Registration

79th Annual Assembly and Exhibition

Attendee Registration Form

Contact Information

___________________________________________________________________

Membership Information

___________________________________________________________________

Registration Type

___________________________________________________________________

Event Attendance

Guest Registration

___________________________________________________________________

Additional Options

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Payment Method

Payment Information

Credit Card Information