Indiana Chapter Electronic Abstract Form

Deadline Friday, September 5, 2014
WARNING: This form is programmed to reject all submission attempts after Midnight, September 5, 2014

Submitted for*
First Author Class*
First Name*
Last Name*
ACP #*	(If you have applied for membership, have not yet received your ACP#, please enter 'pending'.)
Residency Program or Medical School*
Year: (PGY-1, 2, or 3; MS 1 - IV)*
Address 1*
Address 2
City*
State*
Zip*
Home Phone*
E-mail*

Additional Authors (please list, if any)
Program Director's Name
Program Director's Email
Program Director's Phone

Abstract Title*

Please type or copy your abstract in its place. Limit your submission to 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 NOTE: Copying and pasting your e-mail content from Microsoft Word may cause formatting problems. We recommend that you copy your abstract from a text file. *

If you have questions about the Abstract Competition, please contact Donna Seawards, Executive Director of the Indiana Chapter, at donnaseawards@gmail.com or 623-225-5527.

Page posted: May 9, 2014

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Indiana Chapter Electronic Abstract Form