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Quality Matters Conference Registration Form

To help with planning, please complete regarding your plans for participation:

Registrant Information

If you are a resident, what year of residency are you in?

Participation and Housing Information

I will attend/participate on Friday January 23 as follows (check all as appropriate): *
If yes, I will attend the following:
I will attend/participate on Saturday January 24 as follows (check all as appropriate): *
If yes, I will attend the following:
I will need housing for: (Additional information regarding conference hotel block) *
If yes, I will need housing for the following days:
(Lodging information will be provided separately after conference registration is received.)

Louisiana Academy of Family Physicians
919 Tara Boulevard
Baton Rouge, Louisiana 70806

Phone: 225.923.3313
Fax: 225.923.2909
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