EventsAnnual Scientific Conference and ExhibitionAbstracts Submission Form

Abstracts Submission Form

Submitter Information

First Name

Last Name

Title

Credentials

Presenting Author *

Email Address Email Address will not be published.

Phone Number Phone Number will not be published.

Institution/Organization

Department

Address

City

State

Country

Abstract Information

We recommend preparing your research abstract submission in a Word document first, then copying and pasting into the form fields. There is a 300 word limit per section.

Select your abstract category *

Abstract Title The title should be as brief as possible, but sufficiently long to indicate the nature of the study clearly. Capitalize the first letter of each word; do not capitalize every letter.

The title should be as brief as possible, but sufficiently long to indicate the nature of the study clearly. Capitalize the first letter of each word; do not capitalize every letter.

Abstract Description

Background and Purpose:

Methods:

Results:

Conclusion:

I attest to all of the following:

Information on ineligible companies is available on the ACCME website.

I will not use proprietary content in this accredited continuing education activity.

I have not and will not directly receive payments including travel for presenting this content from an ineligible company.

I will inform learners when I discuss or reference unapproved or unlabeled uses of therapeutic agents or products.

I agree to comply with the requirements to protect health information under the Health Insurance Portability & Accountability Act of 1996 (HIPAA).

Presenting Author COI Disclosure

Do you have financial relationships to disclose? * Please note that this is for CDE disclosure. If your abstract is accepted, you may be asked to complete an additional disclosure by the CME provider.

Please note that this is for CDE disclosure. If your abstract is accepted, you may be asked to complete an additional disclosure by the CME provider.

If yes, please list the companies, your role, what was received, and if it is ongoing in the below format: COMPANY; ROLE; WHAT WAS RECEIVED; IS ONGOING Example: Strike, Consultant, Honorarium, No If you have more than one company, please separate information by semicolon Example: Strike, Consultant, Honorarium, No; KLS Martin, Consultant, Consultant Fee, No

List Financial Disclosures If yes, please list the companies, your role, what was received, and if it is ongoing in the below format:
COMPANY; ROLE; WHAT WAS RECEIVED; IS ONGOING
Example: Stryker, Consultant, Honorarium, No

If you have more than one company, please separate information by semicolon
Example: Strike, Consultant, Honorarium, No; KLS Martin, Consultant, Consultant Fee, No

Please review your information to ensure all details are correct before submitting

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