Capitol Day 2017 Registration

Wednesday, February 22

Get on Track with Family Medicine

Wear your white coat

As one of the five goals of the MAFP strategic plan, advocacy is essential when defining the standards of Family Medicine. On February 22, the MAFP will provide our members the opportunity to serve as a unified voice at the MS Capitol.

You are welcome to join us for a portion of the day or the entire day. We need as many white coats and MAFP pins at the State Capitol as possible in order to Get Mississippians on Track with Family Medicine.

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* 1. First Name

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* 2. Last Name

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* 3. Suffix

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* 4. What is your e-mail address?

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* 5. What is your cell phone number?

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* 6. Please select your classification.

Physician

Resident

Medical Student

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* 7. Please select which session(s) you plan to attend.

Morning: 7 am - 12 noon (Breakfast and Screenings)

Lunch and Speakers

Afternoon: 2 - 4 pm (Dessert and Coffee with Legislators)

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* 8. If student or resident, please select year.

Year 1

Year 2

Year 3

Year 4

PGY-1

PGY-2

PGY-3

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* 1. First Name

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* 2. Last Name

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* 3. Suffix

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* 4. What is your e-mail address?

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* 5. What is your cell phone number?

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* 6. Please select your classification.

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* 7. Please select which session(s) you plan to attend.

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* 8. If student or resident, please select year.

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* 9. If student or resident, please provide the name of your medical school or residency program.