Big Sky Family Medicine Update Registration

AAFP ID

First Name^*

Last Name^*

Title/Designation

Address^*

City^*

State^*

Zip^*

Country^*

Phone

Email^*

Event Fee*

	3 Day (M-W)	5 Day (M-F)
NDAFP Members	$475	$625
All other MDs, Dos	$525	$675
PA, NP, Retired MD, & Out of state Resident	$400	$475
ND Students and Residents	Free	Free

Mutually exclusive options for registration.

Free Tuesday Afternoon Family Movie

Adults

Children

Wednesday evening dinner

Attendee (free)

Will Attend

Will Not Attend

Additional Adults

Children (12 & Under)