Please fill out your contact information below before August 1 in order to be considered for the next AAFP Congress of Delegates meeting.

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Credentials

Question Title

* 4. Address Line 1

Question Title

* 5. Address Line 2

Question Title

* 6. City

Question Title

* 7. State

Question Title

* 8. Zip Code

Question Title

* 9. Preferred Phone Number

Question Title

* 10. Email Address

Question Title

* 11. Resolution Title

Question Title

* 12. Resolution Author

Question Title

* 13. Description of Resolution

Question Title

* 14. Why is this resolution important to family physicians?

Question Title

* 15. Upload Resolution in a Word or PDF Document

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 16. Upload Supporting Documentation

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
0 of 16 answered
 

T