Summer Break Away Registration – South Carolina Academy of Family Physicians

Name *

First

Last

Designation

Office #

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

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

*Does not include activities or events. Tickets must be purchased for Activities/Events.

Syllabus (Printed Syllabus not available)

Syllabus - Provided via an internet link before meeting (included in the registration fee) - $0.00
I prefer a USB drive - $45.00

Activities/Events

KSA Working Group (Thursday 2-6 PM) – Heart Disease

Conference Attendee - $195.00
Not Attending - $0.00

WORKSHOP - Point of Care Ultrasound (Thursday 3:15-5:15 PM)

Conference Attendee - $200.00
Not Attending - $0.00

Mix & Mingle Luncheon (Friday) *

Attending - $40.00
Not Attending - $0.00

Ticket must be requested. No Guest tickets available.

Mix & Mingle Luncheon (Friday) *

Attending
Not Attending

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

Family Fun Night - Friday
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)

Past Presidents Breakfast (Friday)

Attending
Not Attending

Must be an SCAFP Past President to attend.

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 11, 2024. After that date, no refunds will be given.

LIABILITY RELEASE: By hitting 'Register' 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.

2025 Summer Break Away Registration

Additional Attendees

Registration

Activities/Events

Payment Information