*1.First Name(Required.)

*2.Last Name(Required.)

*3.Residency Affiliation(Required.)

*4.AAFP/FAFP Member ID #(Required.)

*5.Email(Required.)

*6.President Candidate:(Required.)

Courtney Mangum, MD

*7.Vice President Candidate:(Required.)

Del Carter

*8.Secretary/Treasurer Candidate:(Required.)

Rahil Gour, DO