ACP Michigan Conference Interest Form
NOTE: This is NOT a registration form; we'll send more information later.
ACP Michigan is tentatively planning a statewide conference for spring 2020. Please complete this form so we can create a custom event and maximize your time.
What date(s) would work best for you? (check all that apply)
April 16-17 or 17-18
April 23-24 or 24-25
April 30-May1 or May-1-2
May 7-8 or 8-9
May 14-15 or 15-16
May 28-29 or 29-30
Which format works best for you:
Full day Thursday - Half day Friday
Full day Friday - Half day Saturday
I would be interested in participating the following way(s) (Check all that apply)
Attending the conference
Speaking in a concurrent session
Becoming a sponsor
Promoting the conference
Volunteering the day of
I cannot participate
Continue to the next section to provide speaker/topic input
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This form was created inside of Michigan Primary Care Consortium.