2024 IAFP Advocacy Day and KSA Study Group Question Title * 1. AAFP ID (if known) Question Title * 2. First Name Question Title * 3. Last Name Question Title * 4. Designation (Select all that apply) MD DO Residency graduate in 2020, 2021, 2022, or 2023 Current Resident Current Student Other (please specify) Question Title * 5. Are you a Fellow of the AAFP (FAAFP)? Yes No Question Title * 6. City, State Question Title * 7. Home Zip Code Question Title * 8. Business Zip Code Question Title * 9. Email Question Title * 10. I will attend lunch at the Statehouse from 11:00am-12:00pm Yes No Question Title * 11. I will attend the KSA Study Group on Musculoskeletal Medicine at the Indiana History Center from 1:00pm-5:00pm Yes No Question Title * 12. CONSENT TO USE OF PHOTOGRAPHIC IMAGES: Registration and attendance at, or participation in, IAFP meetings and other activities constitutes an agreement by the registrant for IAFP use and distribution (both now and in the future) of the registrant or attendee’s image or voice in photographs, videotapes, electronic reproductions, and audiotapes of such events and activities. Yes, I consent to use of photographic images No, I do not consent to use of photographic images Question Title * 13. CANCELLATION POLICY: You may cancel without penalty - please email ebohannon@in-afp.org with questions. Done