REGISTRATION FORM

Name:

Circle What Applies: MD DO Fellow NP

Clinic:

Address:

City/State/Zip:

Phone: Fax:

Cell: ___ (For MAFP use only)

E-mail:

Spouse/Guest Name:

Syllabus: Online Hard Copy $75

Registration Fees

□ MAFP Member . . . . . . . . . . . . @ $300

□ MAFP Spouse/Guest . . . . . . . . @ $ 50

□ Non-Member . . . . . . . . . . . . . . @ $400

□ Non-Member Spouse/Guest . . @ $100

Activities (please check appropriate boxes)

□ Crawfish Boil - Friday . . . . . . . . # attending ______

□ Dine Around Dinner……. # attending

BH____ EWBB____ IHG____ PM____

□ Hard Copy Syllabus .. . . . _____ @ $75 each

Are you staying at the Westin? Yes No

Rank From 1-5 Your Breakout Session Preferences: (With ‘1’ as the most important)

( ) Sports Medicine ( ) Value-Based Care ( ) Precepting

( ) Direct Primary Care ( ) Domestic Violence ( ) Risk Mgt.

Total Due . . . . . . . . . . . . . . . . . . . $ __________________

Credit Card Information:

Name as Printed on Card:

Signature:

Billing Street Address:

Billing Zip Code:

Card #:

Expiration Date: Authorization #: (3 digit # on back of card, 4 digit # on front of Am. Exp.)

Amount of Payment: $ Card Type: □ AMEX □ Discover □ Master Card □ Visa

Refunds, minus a $50 administrative fee, will be made upon request in writing to the MAFP office, if received by April 6. After April 6, no refunds will be granted.

Please complete and return with your payment to: MAFP 755 Avignon Drive, Ridgeland, MS 39157

FAX (601) 853-3002

SOUL SPA The Westin Jackson features the Soul Spa on the lobby lev-el. The spa is open from Tuesday through Saturday from 9 am to 6 pm, and Sunday from 10 am to 6 pm. For a full list of treatments, visit www.soulspajackson.com. Call (769) 235-8404 to make appointments.

THINGS TO DO IN JACKSON Visit Jackson www.visitjackson.com Outlets of Mississippi www.outletsofms.com Mississippi Museum of Art www.msmuseumart.org The Jackson Zoo -www.jacksonzoo.org Two Mississippi Museums - www.mdah.ms.gov/2MM

ACCREDITATION Application for CME credit is being filed with the American Academy of Family Physicians for 12 hours. Determination of hours of credit is pending.

Looking for another option to the State of

Mississippi car tag? Ask for our Live Healthy

tag when you renew your tag this year!

Come Fly with MAFP!

70th Annual Scientific Assembly

July 20-24, 2019

Baytowne Conference Center, Sandestin, FL

Details and Registration:

www.msafp.org/annual

CME TOPICS

Testosterone Replacement in Men Michael Manning, MD, of Mississippi Vein Institute

Psoriasis: Overcoming Challenges in Diagnosis and Treatment Steven R. Feldman, MD, PhD

Wake Forest University School of Medicine, Winston-Salem, NC

Dermatology Update Adam Byrd, MD, Louisville, MS

Sickle Cell Disease John J. Strouse, MD, PhD

Duke University School of Medicine, Durham, NC

Vaping and JUULing Risks Thomas Payne, PhD

UMMC Dept. of Otolaryngology and Communicative Sciences

Influenza: Understanding and Communicating Risk to Reduce Mortality -- Dr. Stefan Gravenstein, MD, MPH,

Brown University School of Medicine, Providence, RI

How to Be a Rock Star Doctor Rebekah Bernard, MD, Gulf Coast Direct Primary Care

Financial Planning Seger Morris, DO, Corinth, MS

Quality Improvement Research Projects MS Family Medicine Residents

BREAKOUT SESSIONS Saturday 1-4 pm

Real-Life Hero Training With Drs. Brent Smith and Jeremy Wells

Participate in hands-on training for real-life emergencies, when a doctor has the opportunity to step up and make a difference to an injured person. Critical care topics include: sports field and spinal injuries, defibrillator training and cardiac assessment, tourniquet training, and splinting for wilderness/sports injuries.

Value-Based Care vs. Fee-for-Service Samuel N. Crosby, MD, FAAFP, Hattiesburg Clinic

Basics of Direct Primary Care Rebekah Bernard, MD, Gulf Coast Direct Primary Care

The Joy in Precepting -- Speaker TBA

Domestic Violence Update Melissa Stephens, MD, FAAFP, Assoc. Professor of Clinical Sciences

William Carey University College of Osteopathic Medicine

Case Reviews from a Claims & Risk Management POV Kathy Stone, Vice President, MACM Risk Managament

TENTATIVE SCHEDULE

Friday, April 12, 2019 4 - 6 pm MAFP Board Meeting - MAFP Office 6:30 pm Crawfish Boil at The Lake House Saturday, April 13, 2019 7 - 8 am Breakfast with Exhibitors 7 am - 3 pm Exhibits Open 8 am - 4 pm CME Sessions & Workshops 6:30 pm Dine Arounds for Dinner Sunday, April 14, 2019 7 am Foundation Board Meeting 7:30 - 8 am Breakfast 8 am - 12:30 pm CME Sessions

EXHIBITS Exhibitors will be present from 7 am - 3 pm Saturday and prizes will be given to physicians who visit each exhibitor.

HOTEL ACCOMMODATIONS The Westin Jackson is located at 407 South Congress Street in Downtown Jackson. Rates are $139 plus tax per night. Please make reservations by calling 800-937-8461. Remember to mention MAFP to receive our group rate. The room block deadline is April 1. The 9-story Westin is brand-new, having opened in August 2017, and it features an in-house restaurant and spa. The Westin offers valet parking for our registrants in a secured lot for $10 per day. Street parking may be available, but please check to make sure you won’t be ticketed.

EVENTS Crawfish Boil • Friday • 6:30-8:30 pm. Sponsored by Blue Cross Blue Shield of MS. Join us at The Lake House at the Reservoir for a n i g h t o f c r a w f i s h , l i v e entertainment and lots of fun. Enjoy the evening and network with other MAFP members, medical students and residents. Overlooking the water of the Reservoir, the Lake House offers the perfect event location. It is located at 135 Madison Landing Circle in Ridgeland. Transportation is on your own. The Crawfish Boil fee is included in registration. MAFP Dine Around Dinner • Saturday • 6:30 pm The MAFP is offering Dine Around Dinners - an evening of good food and fellowship with MAFP colleagues. Dine Around attendees will be responsible for paying for their own meals and drinks. Please see the list of options below, and check the websites provided for menus. The MAFP will make reservations and coordinate groups in advance, so please

reserve restaurant and number attending by April 5. Dining Choices (Saturday night Dine-Around):

Barrelhouse (Fondren) • Southern Gastropub • $$-$$$ • barrelhousems.com

Estelle Wine Bar & Bistro (inside the Westin) • Contemporary American • $$-$$$ • estellejackson.com

Iron Horse Grill (Downtown) • Steak, Mexican, American • $$-$$$ • www.theironhorsegrill.com

Parlor Market (Downtown) • Award-winning Southern fusion • $$-$$$ • parlormarket.com Westin Hotel, Downtown Jackson