Media Center Main Page

Media Registration Form

Please fill out this form for each member of the media wishing to attend AAFP events. (Only working media will be allowed to register; sales and public relations staff cannot be registered as media.)

Fields marked with a * are required.

* Freelance writers must submit a letter of assignment or letter of intent from the media outlet being represented. Letters can be e-mailed from assigning editor to Barbara Kowalski at bkowalsk@aafp.org or faxed to 913-906-6089.

Please review the All Event Media Guidelines prior to registering for this meeting.

Note: Media attending the AAFP Scientific Assembly are allowed to enter strictly for viewing/reporting purposes only. The soliciting of exhibitors and/or physicians is strictly prohibited. Any company or publication representative that solicits exhibitors or physicians will be considered in violation of AAFP rules and regulations. If such a violation occurs, the representative's company will not be allowed to attend, in any capacity, future AAFP meetings. The AAFP reserves the sole right to determine if a violation has occurred and to remove the solicitors and/or their company from the exhibit floor. Exhibitors and physicians have been asked to inform the convention staff of any solicitations they receive.

All-Event Media Registration

Media Registration Form

*Event: Have you covered this event before? Yes No Are you covering a particular topic or event? Yes No If yes, please note:
*Date of request (today's date):
*Name: (first, last)
*Position/Title: (correspondent, editor, writer, photographer, etc.)
*Affiliation: (publication, station/channel, *freelance, etc.)
*Street Address:
*City:
*State:
*ZIP Code:
Phone Number:
Fax Number:
*E-mail: