Register Here – South Carolina Academy of Family Physicians

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

State Chapter *

Position in Your State Academy *

Spouse/Guest Name

(if attending - for badge)

First

Last

Children's Names/Ages

(if attending - for badge)

Emergency Contact Name

First

Last

Emergency Contact Phone #

Date of Arrival

Date of Departure

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

If yes, please notify us by 8/9/2025 so that someone from the SCAFP Office can contact you in order to receive services.

Special Needs

of Email Reception

Reception Thursday

Thursday Reception Number of Tickets

Number of Tickets Requested

Thursday Dinner

Thursday Dinner Additional Tickets

Number of Guest Tickets: $60.00 ea.

Total for Events

$0.00

Stripe Credit Card *

Registration