PACEP SA22 CPC Submission

PACEP SA22 CPC Submission

Please email alexandra.amducci@lvhn.org with any questions.
I want to be considered for these presentation options:*

Case CompetitionCPCBoth
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
If submitting for CPC Faculty Discussant
Name, Email, Phone Number

Please list ALL authors in order if the submission is being considered for the case competition. Do not forget to appropriately place the presenting author in this list.

	First Name	Last Name	Credentials
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:
Author:

Case Title
Please upload CPC and/or Case Competition file as a word or PDF File*

Browse Files

Cancelof
I certify that this case is fully HIPAA compliant.

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