MDAFP-F Virtual Trivia Event Registration

MDAFP-Foundation Virtual Trivia Event

Registration Form | Registration deadline is 2/27/21
When: Sunday, February 28

Time: 4-6pm

Location: Virtually anywhere, via Zoom!
- Individual Registration - $15/person
- Team Registration - $50/team
  Up to 4 players per team
Registration Type *

Individual Team
Team Information

If registereing as an individual participant, please leave this section blank.
Team Name
Get creative!
Please list your team member names & email addresses
Optional Additional Donation to the MDAFP-Foundation

All proceeds will benefit the Students to National Conference campaign, a program supported by the MDAFP-Foundation that is critical in strengthening and affirming medical students' decision to pursue a career in Family Medicine.
Please select additional contribution amount

$10 $20 $50 $100
Subtotal

Please type Total *

USD Description

Name *

First Name Last Name
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Thank you for registering for the first-ever MDAFP-F Virtual Trivia Event as part of MDAFP's Annual Meeting and Winter Refresher! MDAFP-Foundation staff will contact registered participants to provide event details (zoom link & trivia instructions).

We look forward to seeing you virtually on February 28th!
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MDAFP-Foundation Virtual Trivia Event