Summer Break Away Registration – South Carolina Academy of Family Physicians

Name *

First

Last

Title

Office #

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Additional Attendees

Spouse/Guest Name (if attending - for badge):

Children’s Name/Ages (if attending - for badge):

Emergency Contact Name:

Emergency Contact Number: *

Date of Arrival: *

Date of Departure: *

AAFP ID Number:

Do you have any special needs that require specific accommodations in order to participate? *

Yes
No

If yes, please notify us by 5/10/2024 so that someone from the SCAFP Office can contact you in order to receive services.

Registration

The registration fee includes the continuing medical education (including the Opioid Prescribing course), online syllabus, access to the Exhibit Hall, Refreshment Breaks and Continental Breakfast, Mix & Mingle Lunch and Installation Luncheon.

Please Select Appropriate Fee

*Registration fee waived, however, does not include activities or events. Tickets must be purchased for Activities/Events.

Prescribing & Monitoring Controlled Substance Course

I wish to only attend the 2-hour substance course on Saturday, June 6th and not the entire conference. - $75.00

This selection is only for those that do not wish to attend any other part of the conference and wish to only attend the 2 hour opioid session.

Activities/Events

KSAs Working Group (Thursday 2-6 PM) – Care of Women

Conference Attendee - $195.00
KSA ONLY for Non-Conference Attendee (KSA Only) - $250.00

Workshop - Nexplanon Training (Friday 3:15-5:15 PM)

Conference Attendee - $75.00
Non-Conference Attendee - $100.00

Past Presidents Breakfast (Saturday)

Attending (must be an SCAFP Past President to attend)
Not Attending

Mix & Mingle Luncheon (Friday) *

Attending
Not Attending

Registrant ticket COMP - ticket must be requested. No Guest tickets available.

Family Fun Night - (Friday) Theme: Fiesta
Select the number of adult and child tickets for Family Fun Night.

Family Fun Night Adult Tickets

Family Fun Night Child Tickets (ages 3-10)

Installation Luncheon (Saturday) *

Attending - $40.00
Not Attending - $0.00

If you need additional adult or child tickets choose the ticket quantities below.

Installation Luncheon (Saturday)

Attending
Not Attending

Installation Luncheon ticket is free for registrants. If you need additional adult or child tickets choose the ticket quantities below.

Additional Installation Luncheon Adult Tickets

Additional Installation Luncheon Child Tickets

Total

$0.00

Payment Information

Payment Method: *

Credit Card
Mail a Check

Check Number

Mail checks to:
SCAFP
PO Box 312
Laurens, SC 29360

Credit Card Info *

CANCELLATION POLICY: Refunds, minus an administrative fee, will be made upon written request to the SCAFP office if received by May 4, 2026. After that date, no refunds will be given.

LIABILITY RELEASE: I waive and release any and all rights and claims for damages I may have against the SCAFP, its employees and representatives, for damages incurred during the course of this meeting realizing that the SCAFP staff has taken reasonable precautions to ensure my safety.

2026 Summer Break Away Registration

Additional Attendees

Registration

Activities/Events

Payment Information