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Get FAMILY PHYSICIAN INSURANCE PROGRAM AAFP MEMBER ...

Ete and return this form to The Plan Administrator: AAFP Insurance Services, Inc., AAFP Headquarters, Suite 430, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 Questions? Call 800-325-8166 Fax: 800-223-7463 Web: www.aafpins.com E-mail: insurance aafp.org Please print in ink or type all answers. Please initial and date any changes you make. Do not use gel pens or correction fluid. AAFP MEMBER INFORMATION AAFP Member Full Name Spouse.

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