2024 FMM Residency Showcase Exhibit Application

Each exhibit booth includes one free conference registration for your program. We encourage as many of your program's faculty and residents to register for the conference and attend the sessions and networking events. Each additional registrant will get a discounted rate.

Each exhibit will include a table and two chairs, no pipe and drape.

Two related programs may share one booth and split the fee, but will need to purchase one additional registration.

Payment is due by September 15 or the booth will be reassigned to a program on the waitlist.

Booths will be assigned on a first come first served for fully paid exhibits, with a priority on keeping state's programs near each other. Credit card payment with your application is strongly recommended.

If you have any questions about registration, please call Ginnie Flynn at 773-754-1185 or email gflynn@iafp.com.
Residency Program Primary Contact
First Name*
Last Name*
Title*
Residency Program Name as it should be listed *
ACGME Number*
Program Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website*
Primary Contact Email Address*
Phone Number*
Program's public email address*
example@example.com
Program Director's Name, if not the primary contact listed above (so we can invite them to the PD meeting)
Program Director's Email
example@example.com
Does your program offer J-1 Visas?*

YesNoCase by case basis
Does your program interview/consider international students?*

YesNoCase by cases basis
You can provide any additional details for International students here
Please provide 1-2 sentences summarizing your program*
If we could offer an informational session on Fellowships for resident attendees Saturday, October 19 would your institution like to participate and offer information about your fellowship programs?

YesNoWe don't have any fellowships at my institution
List the Fellowships offered at your institution

About your participation
We will provide an invoice to your program by email or you can pay by credit card below*

Residency Showcase participation at $900Please email me an invoice, I cannot use the CC processor belowWe will share our booth with another program
Do you require electricity at your booth*
If you are sharing a booth, please list the other program's official name here
Secondary booth
Please list the name of the 1 representative who will use the free registration, or TBD if you are not sure. You can submit that person's name via email to gflynn@iafp.com by September 15*
Any additional information or other requests for billing purposes:

Credit Card Payment

USDTotal payment

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty: