Registration

80th Annual Assembly and Exhibition

Attendee Registration Form

Contact Information

First Name *

Last Name *

Designation

Mailing Address *

Address 2

City *

State *

Zip *

Phone Number: *

Cell Phone Number: *

Email Address: *

___________________________________________________________________

Membership Information

Member of LAFP? *

Yes

Type of Member *

AAFP ID# *

Specialty

___________________________________________________________________

Registration Type

PLEASE NOTE: Daily registration fees include virtual and in-person attendance. If you are attending in-person the daily rate includes CME and breaks with exhibitors only. Tickets required for social events! Full on-site registrations include all events.

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Event Attendance

Please select which functions below that you will be attending. If doubtful, please leave blank. This will aid LAFP in receiving an accurate count for meals and social events. These events are included in full registrations, however RSVP is required. Additional tickets may be purchased below. PLEASE NOTE: Daily registrations include CME and breaks with exhibitors only. Tickets required for social events!

Thursday, July 22, 2027

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

Breakfast with Exhibitors

Refreshment Break

Lunch with Exhibitors

Welcome Reception (7 pm - 9 pm) *RSVP req'd

Friday, July 23, 2027

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

Breakfast with Exhibitors

Refreshment Break

General Assembly (LAFP Members only)

Awards and Installation Ceremony

President's Party and Foundation Fundraiser

Saturday, July 24, 2027

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

Breakfast with Exhibitors

Residency Program Directors Meeting (Residency Directors ONLY)

Refreshment Break

Lunch

Sunday, July 25, 2027

Breakfast Symposium (In-person attendee)

CME Sessions (Virtual attendee)

CME Sessions (In-person attendee)

Guest Registration

Guest registration is $80 for an adult or child and includes admission to the Welcome Reception, Awards & Installation Ceremony and President's Party/Foundation Fundraiser.

Number of Guest(s)

Guest 1

Adult or Child? *

First Name *

Last Name *

Guest 2

Adult or Child? *

First Name *

Last Name *

Guest 3

Adult or Child? *

First Name *

Last Name *

Guest 4

Adult or Child? *

First Name *

Last Name *

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Additional Options

Student Sponsorship

Foundation Golf Tournament (Thursday, July 22)

Golfer(s) Names *

Golfer(s) Shirt Size(s) *

President's Party/Foundation Fundraiser (Friday, July 23)--for guests & daily registrations

Names

Awards and Installation Ceremony--(Friday, July 23)--for guests & daily registration

Names *

Donation to LAFP Foundation (number only)

Donation attributed to

T-Shirt Size *

___________________________________________________________________

How did you hear about this meeting? (select all that apply)

Weekly Newsletter

LAFP website

LA Family Doctor Journal

Mailing

Social Media

Other

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Please list any special dietary restrictions.

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NOTE: A non-refundable 3.5% credit card process fee will be applied to all credit card payments.

Payment Method

Please select method of payment. *

Pay by Check

Credit/Debit Card

Payment Information

Amount

Payment Method

Selected Above

Credit Card Information

Card Holder Name

Credit Card Number

Expiration Date

Card (CVV) Code

Billing Zip Code

CANCELLATION POLICY: Refunds, less a $100 administrative fee will be issued upon written request until April 1, 2027. You may cancel your hotel room with a full refund if cancelled 7 days in advance of stay.

If you have any questions or comments, please contact the LAFP office at (225) 923-3313 or send an e-mail to info@lafp.org.