2019 NCAFP Annual Meeting: Winter Family Physicians Weekend in Asheville, NC (student interest form)
December 5-8, 2019 ~ Asheville, NC

Although it's a wonderful problem to have, due to space limitations and the overwhelming interest from students and our entire membership to attend this annual conference, we need to limit the number of attendees. Please be sure to read the below information thoroughly, and answer all questions.

Deadline to submit this form is November 10th. If approved, you must register for the conference no later than November 15th.

IF YOU ARE COMPLETING THIS AFTER 11/10 and/or YOU ARE A NON-MEMBER as of 11/10, PLEASE BE AWARE YOU WILL AUTOMATICALLY BE ADDED TO THE WAITLIST UNTIL A SPOT IS AVAILABLE OR YOU SHOW AS AN AAFP/NCAFP MEMBER.

GENERAL INFO:
1) No student will be allowed to attend the conference without completing this form.
2) Students must be members of the AAFP/NCAFP - if you are not a member, join now: www.aafp.org/join
3) If you are a 4th year med student participating in the match in 2020, you must be interviewing at FM residency programs; we cannot accommodate MS4s pursuing other specialties - sorry!
4) Once you are approved to attend the conference, please follow the next steps provided to you. Register as soon as you can, but NO LATER than 11/15. If you don't register by that date your spot may be forfeited to a student on the wait-list. Make your hotel/Airbnb reservations as soon as you are given the go-ahead to register. Or, make refundable arrangements immediately, then cancel if need be. Lodging can be very difficult to find at the last minute.

REQUIRED ACTIVITIES:
Students are encouraged to attend anything of interest; however, ALL students are expected to attend / complete the following:
1) General Education session on Sat. 12/7 - 9:00am - 10:00am - students & residents will be
asked to stand/ be recognized - you are expected to attend and remain for this entire general session.
2) Student Section Business Mtg / Workshop - Saturday 12/7 - 12:30 - 2:15 pm (lunch provided)
3) Complete an online conference evaluation at the conclusion of the conference.

For questions please contact Tracie Hazelett at NCAFP offices: thazelett@ncafp.com or 919-980-5357.

Email address *
Full Name *
Your answer
What are you passionate about as it relates to family medicine? *
Your answer
How are you deciding which specialty is right for you (i.e. faculty, mentor, role model, etc.) *
Your answer
What are your goals as a future physician and will attending this conference help you further achieve them? *
Your answer
AAFP Member ID# *
Your answer
Mobile Phone# *
Your answer
Medical School *
Expected Graduation Year *
How did you hear about this conference? *
Check all that apply
Required
As an AAFP/NCAFP student member enrolled in a NC med school, you are eligible for travel support to attend this conference. Do you want/need a travel stipend from the NC AFP to help offset your hotel expenses? *
If you are interested in this award the amount is $175 / student. If you are not interested in the travel stipend this $ will continue to be used for students via other NCAFP Foundation student interest initiatives.
Current COMPLETE MAILing Address (incl street, city, state and zip). *
If you are the recipient of funding, this is the address we will use to mail a check after the conference. Please make sure it's a valid, complete address, including STATE and ZIP code for a check to be received between December 18 - January 1.
Your answer
Are you a member of your Family Medicine Interest Group / Club on campus? *
Do you plan to submit a poster for our Research Poster Contest? *
Deadline to submit your research is 10/1/19. Visit: https://www.ncafp.com/residents/rpp/ for more details.
Have you attended this conference in Asheville before? *
At this moment, how sure are you about your attendance? *
Please indicate intended date of arrival in Asheville *
The conference officially kicks off Thurs. 12/5 at 7AM. You are welcome to arrive any time however, all student/resident activities are Friday/Saturday. If you are presenting a research poster you must have it displayed no later than 10:30am Friday, 12/6. For complete up-to-date conference & schedule details please visit: www.ncafp.com/wfpw
Intended date of Departure from Asheville *
Are you interested in carpooling? *
Are you interested in being connected with students (including those from other schools) that want to share lodging expenses? *
If you answer yes, your e-mail and cell # as noted above will be provided to other interested students so you can connect
Other Comments or Clarifications you would like to make?
Your answer
A copy of your responses will be emailed to the address you provided.
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