Letter of Intent for MDS Virtual Video Challenge 2021

Letter of Intent for MDS Virtual Video Challenge 2021

Due: March 30, 2021
NOTE: Cases that are to be presented at the MDS Virtual Video Challenge should not be presented as an abstract in the Poster Areas.
Contact Person
Full Name

First Name Last Name
E-mail
example@example.com
Organization/Group Submitting Case
Name of Organization/Group

Street Address Line 2

City State / Province

Country
Case Submission #1
Title of case:
Brief summary of case:
Description of what the video will demonstrate:
Statement of why the case is unique or of interest:
Case Submission #2
Title of case:
Brief summary of case:
Description of what the video will demonstrate:
Statement of why the case is unique or of interest:
Case Submission #3
Title of case:
Brief summary of case:
Description of what the video will demonstrate:
Statement of why the case is unique or of interest:
The author(s) of the Work hereby represents and confirms that he/she has obtained the written consent of any and all patient(s) featured or who are otherwise identifiable or used in the Work to such feature, identification or other use therein and that said consent fully complies with all applicable legal requirements relating to the use of said such patient identifiable material, including, without limitation, if applicable, the specific requirements of the United States Health Insurance Portability and Accountability Act of 1996 ("HIPAA").
By submitting this Letter of Intent, you agree to the above and your case(s) will be reviewed by a committee. By the end of April 2021, notifications will be sent out indicating the cases that will be formally considered for review and possible presentation.
Should be Empty:

Letter of Intent for MDS Virtual Video Challenge 2021

Contact Person

Organization/Group Submitting Case

Case Submission #1

Case Submission #2

Case Submission #3