2026 NCS-ACOFP Conference Attendee Registration Form

Name and Degree (e.g., DO, MD, PA, FNP, OMS)*

First NameLast NameDegree

Email*

example@example.com

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If you are a practicing physician, please enter the physical address of your practice.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

The registration fee includes breakfast, lunch and snacks. If you have any dietary allergies, please describe below.

Registration Fees (Early Bird Rates listed below are effective until July 1st.)*

Active Duty Military Physician

$275.00

Retired Physician

$325.00

NCOMA or NCS-ACOFP Physician Member

(You must be a member of one of the NC chapters for this rate to apply. Membership will be verified.)

$475.00

Non-member Physician

(Rate applies to physicians who are not a member of NCS-ACOFP or NCOMA. )

$575.00

Student

$35.00

Resident

$75.00

Other Health Care Professional (PA, RN, FNP, etc. )

$275.00

Guest for Saturday evening reception

(There is no charge for children under age 16.)

$40.00 Quantity

Donation to Sponsor Student and Resident Attendance

Your donation will be used to assist with paying hotel costs for students and residents to attend the conference.

$100.00 Quantity
Item subtotal:$0.00

Total

$0.00