Tar Wars - Iowa Academy of Family Physicians

Tar Wars

Tar Wars Presenter Application

If you would like to be a presenter, please submit the following form.

* denotes required field

First Name: * 
Last Name: * 
Address: * 
City / State / Zip Code: *   / /
Daytime Phone: * 
E-mail: * 
Communities you would prefer   
to work in (if possible):   
Please check one: *  Family Physician
Resident
Medical Student
Other
 
© 2012 Iowa Academy of Family Physicians. All Rights Reserved.