PACEP SA22 Spivey Abstract Submission

PACEP SA22 Spivey Abstract Submission

*Please email bryan.kane@lvhn.org with any questions.
Submission Date:*

MonthDayYear
Primary Presenter First Name:*
Primary Presenter Last Name:*
Primary Presenter Email*
example@example.com
Primary Presenter Cell Number*

Area CodePhone Number
Primary Presenter Credentials:*
Primary Presenter Institution:*
Primary Presenter ACEP Number:
Primary Presenter Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact information if submission is being completed by someone other than primary presenter.
Name, Email, Phone Number

Please list ALL authors in order. Do not forget to appropriately place the presenting author in this list.

I want to be considered for these presentation options:*

ElectronicPlatformEither Electronic or Platform
Abstract Title*
Please upload abstract as a Word document or PDF file only:*

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I certify that this research has been approved by and complies with my institution's review committee for human and animal experimentation, where appropriate. I also attest that the project was reviewed and approved by an IRB. IRB designation as exempt (i.e. HSRD) is acceptable.

If accepted, the primary presenter will register for the conference.
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