2010 Annual Meeting and Scientific Symposium Registration Form
Questions marked by * are required.
1.	*Your Email Address:
2.	*Physicians Name (as you prefer it on your name badge):
3.	Full Four-Day Conferenc Registration Fees: Alabama AFP member ($385) Alabama AFP Life Member ($190) Non-Member/Allied Health Professional ($425) Resident AAFP Member (No Fee) Resident Non-AAFP Member ($130) Student AAFP Member (No Fee) Two-Day Conferenc Registration Fees: Alabama AFP member ($200) Alabama AFP Life Member ($95) Non-Member/Allied Health Professional ($235) Resident AAFP Member (No Fee) Resident Non-AAFP Member ($75) Student AAFP Member (No Fee*)
4.	Activities Registration and Fees Thursday Business Breakfast for members only. (No Fee) I will attend I will not attend Get Acquainted Party. (No Fee) people in my family will attend. Saturday I will need Annual Banquet Tickets. (No Fee) I will need Additional Annual Banquet Tickets - Audult -$50 each. *I will need Additional Annual Banquet Tickets - Child - $30 each.
5.	*Choose Payment Type: VISA MasterCard Discover American Express Check (make them out to Alabama Academy of Family Physicians):
6.	Credit Card Number:
7.	Expiration Date:
8.	Verification Code:
9.	Billing Address:
10.	*Telephone:

Hotel Registration

When calling for your hotel reservations mention that you want a room in the Alabama Academy of Family Physicians room block. Our Group Code is 21Y19V. You can book your reservations on line at http://www.Sandestin.com/21Y19V.aspx

Deadline for making hotel reservations in our room block is May 22, 2010.

Sandestin Golf and Beach Resort
9300 Emerald Coast Parkway West
Destin, Florida 32550
1-800-320-8115 or FAX 850-267-8221

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*Full Four-Day Conferenc Registration Fees:

Two-Day Conferenc Registration Fees:

Activities Registration and Fees

Hotel Registration

Deadline for making hotel reservations in our room block is May 22, 2010.