Midwest 2022 Annual Meeting Call for Abstracts

Abstract Poster Presentation Proposal

Submission Form

MIDWEST 2022 REGIONAL MEETING
November 11-13, 2022 | Chicago, IL

Palmer House Hilton | 17 E Monroe Street | Chicago, IL 60603

Click here for Abstract and Poster Presentation Submission Guidelines

After reading the guidelines, please complete the form below and attach presenter's CV and supporting documents near the end of this form before clicking submit. Questions can be directed to Savannah Gold at sgold@asipp.org or 270-554-9412 x 219.

Submission Deadline Extended to: October 31, 2022

**All Fields are Mandatory**

________________________________________________________________________________

Category*

Resident/FellowPhysician

Poster Presentation Title*

(60 character maximum, including spaces)

Author and Presenter Information (include credentials)

First Author*

Co-authors(s) - list all*

Primary Presenter*

Contact Person*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Telephone:*

Primary Presenter Phone During Meeting*

Area CodePresenter Mobile

Fax:

E-mail*

First Author Affiliations*

Co-author Affiliations*

Click here for Poster Presentation Submission Guidelines

I agree to the Poster Presentation Guidelines*

NameDate

ABSTRACT INFORMATION

Background*

Objective*

Methods*

Results*

Conclusions*

Financial Disclosure*

References*

Encore Presentation*

Encore Presentation

Upload attachments or additional information

Upload Presenter's CV*

By submitting this form, I agree to the Abstract and Poster Presentation Guidelines:*

First NameLast Name

Submitted on:*

MonthDayYearHourMinutesAM/PM Option

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