2021 ASIPP Annual Meeting Call for Abstracts

Abstract Poster Presentation Proposal

Submission Form

ASIPP® 23rd ANNUAL MEETING
June 24-26, 2021 | New Orleans, LA

Hilton New Orleans Riverside | 2 Poydras Street | New Orleans, LA 70130

Click here for Abstract and Poster Presentation Submission Guidelines.

After reading the guidelines, please complete the form below and submit along with the presenter's CV. Questions can be directed to Savannah Gold at 270-554-9412 x 4219 or sgold@asipp.org.

- Selected manuscripts will be presented in electronic poster presentation.
- Top 25 will be published in the Pain Physician Journal.
- Top 10 will be selected for abstract presentation at meeting.
- Top 3 will receive cash prizes.

A $50 submission fee is required, and will be collected at the end of this form.

DEADLINE EXTENDED: Proposals will be accepted until May 14, 2021

**Fields with an Asterisk are Mandatory**

________________________________________________________________________________

Category *

Resident/Fellow Physician

Poster Presentation Title *

(60 character maximum, including spaces)

Author and Presenter Information

First Author *

Include credentials such as MD, DO, PhD, etc.

First Author Affiliations *

First Author Mobile Telephone: *

First Author Email *

example@example.com

Second Author *

Include credentials such as MD, DO, PhD, etc.

Second Author Affiliations *

Second Author Mobile Telephone: *

Second Author Email *

example@example.com

Third Author *

Include credentials such as MD, DO, PhD, etc.

Third Author Affiliations *

Third Author Mobile Telephone: *

Third Author Email *

example@example.com

Additional Co-authors (List Names, Credentials, Affiliations, Mobile Phone and Emails for Each Person) *

Presenter Name *

Include credentials such as MD, DO, PhD, etc.

Presenter E-mail *

example@example.com

Presenter Mobile Telephone: *

Primary Contact Person for Group if Other Than First Author

Contact Person

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Contact Person Mobile Telephone:

Contact Person E-mail

Click here for Poster Presentation Submission Guidelines

I have read and agree to the Poster Presentation Guidelines *

Name Date

ABSTRACT INFORMATION

Background *

Objective *

Methods *

Results *

Conclusions *

Disclosure *

References *

Encore Presentation *

Encore Presentation

Upload attachments or additional information

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Upload Presenter's CV *

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By submiting this form, I agree to the Abstract and Poster Presention Guidelines: *

First Name Last Name

Submitted on: *

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Abstract Submission Fee *

Abstract Submission Fee $ 50.00

Total $ 0.00

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