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Student and Resident/Fellow Member Abstract Competition

Deadline - April 30, 2014
WARNING: This form is programmed to reject all submission attempts after 11:59 PM, Wednesday, April 30, 2014

Note: Fields marked with * are required.

*First Name:
*Last Name:
*ACP #:
(If you have applied for membership, have not yet received your ACP#, please enter 'pending'.)
*Address 1:
Address 2:
*City:
*State:
*Zip:
*Phone:
Fax:
*E-mail:
*Select type of submission:
*Select One: Medical Student
  Name of Medical School:
  
  Name of Clerkship Director
  
  E-mail Address of Clerkship Director:
  
  Name of Support Staff:
  
  E-mail Address of Support Staff:
  

Resident/Fellow Member
  Name of Residency Program:
  
  Name of Program Director
  
  E-mail Address of Program Director:
  
  Name of Support Staff:
  
  E-mail Address of Support Staff:
  

Abstract

*Title:
*Author:
*Co-author:
*Institution:
*Limit the body of the abstract to be 450 words or less. Type single-spaced. For electronic submission, you do not need to stay within the borders. The abstract form does not accept graphs, charts, tables, etc.


Please only click 'Submit' one time. You will receive an e-mail when your abstract has been submitted. If you don't get a confirmation, or if you have a question about your submission, please contact Jan Wrassman, Ohio Chapter: jwrassman@fuse.net

Page updated: January 30, 2014