FMIG Faculty Community Form

1. First and Last Name

2. Email Address Note: The online community system will default to using the email address in your personal AAFP profile if you already have one. If you provide an email address in this form that is different from the one in your AAFP profile, we may contact you for clarification. This question requires a valid email address.

3. Designation
(MD, DO, PhD, APRN, etc.)

4. Medical School

5. Title

6. Role in supporting your FMIG

8. If you are a member, please enter your member ID This question requires a valid number format.