Registration for Advocacy Day

Please fill out the form below to secure your spot. Registration is free for KMS members. Space is limited, so early registration is encouraged!

Questions? Contact Nancy Sullivan at (785) 235-2383 or nsullivan@kmsonline.org.

First Name *

Middle Initial

Last Name *

Suffix

Degree

MD

DO

Specialty(s) [Select all that apply] *

Kansas Academy of Family Physicians

Kansas Association of Osteopathic Medicine

American College of Emergency Physicians, Kansas Chapter

Kansas Academy of Physicians Assistants

Kansas Society of Eye Physicians & Surgeons

American College of Obstetricians & Gynecologists

Kansas Dermatological and Surgery Society

Kansas Society of Anesthesiologists

American College of Surgeons, Kansas Chapter

KS Rad Society

American College of Physicians, Kansas Chapter

Other

Email *

Home Address *

City, State Zip *

Phone *

Anti-spam Captcha *

5 - 19 =

Submit