AMWA DocPreneur Abstract and Pitch Challenge

AMWA Innovation Challenge 1.0

Please fill out this questionnaire to serve as an Executive Summary to guide your 5 min pitch presentation deck (an additional 2 minutes will be available for questions). Startup pitches are now CLOSED. Selections and notifications of finalists for the Startup Pitches will be made by December 15, 2022. The abstract submission deadline has been EXTENDED to February 10, 2022 @ 11:59 PST. Finalists must acknowledge in-person participation and AMWA meeting registration.
Presenter Information
Name*

First Name Last Name Degrees/Fellowships (e.g. MD, MPH, FACP)
E-mail*
Phone Number*

Area Code Phone Number
Institution/Affiliation*
Professional Title*
e.g. Assistant Professor at Harvard, Instructor
Are you an AMWA member?*

YesNo
I am applying for (instructions will appear once you select one)*

Abstract for Poster Only
Please complete this Abstract section if you are submitting the Abstract ONLY. Disregard any pitch questions with N/A.
Please complete both the Abstract section and the Pitch section if you would like to submit both an abstract and a pitch for review.
Please complete the Pitch section if you are submitting the Pitch ONLY. Disregard any abstract questions with N/A.
One-Line Pitch (will be used for marketing materials for the Pitch Competition or Poster Session, if accepted)*
Company Description (Limit 300 words. Will be used for judging.)*

0/300
Company Description (Two-sentence description. Will be used for marketing.)*
What is your product or service? (Limit 300 words. Will be used for judging) *

0/300
What is your product or service? (Two-sentence description. Will be used for marketing).*
Define your target market. Who will buy it and why? What customer needs is your company addressing? (Limit 300 words) *

0/300
Please outline your current intellectual property strategy. What other barriers of entry do you anticipate, if applicable? (Limit 300 words)*

0/300
Where are you now in the process of formulating a regulatory plan? Please describe your regulatory plan, if applicable. (Limit 1 paragraph)*
Who do you consider as your competition? How are you differentiated? (Limit 300 words)*

0/300
How have you validated your idea? What preliminary data or proof of concept do you have? (Document upload)*

0/300
Please describe your business model (i.e. Clear Revenue, Sales Cycle, Lifetime Value, Recurring, One-time, etc.). (Limit 300 words)*

0/300
Identify your key team members, advisers, and their affiliations. (Limit to 1 paragraph)*
Please upload your pitch deck and supplemental materials, if available, for consideration.

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Additional file upload.

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The following questions pertain to abstract permission.
Do you or any of your co-authors have any financial disclosures?*
If you have financial disclosures, please describe below:
How many co-authors are listed on your abstract, including yourself (Please enter a numerical value between 1 and 10. ex. 3)?*
Have ALL abstract authors agreed to poster submission & abstract presentation for the AMWA 2023 Meeting? (ALL authors will be notified of your submission.)*
Please enter the names and email addresses of the co-authors in the text fields below (INCLUDING yourself). These fields will only be present if you have entered a numerical value other than 0 above (do not worry about entering the authors in the correct order here, however, please make sure they are listed in the correct order in the abstract submission box).
Author 1 Name (Presenting Author)*
Author 1 Email (Presenting Author)*
Author 2 Name
Author 2 Email
Author 3 Name
Author 3 Email
Author 4 Name
Author 4 Email
Author 5 Name
Author 5 Email
Author 6 Name
Author 6 Email
Author 7 Name
Author 7 Email
Author 8 Name
Author 8 Email
Author 9 Name
Author 9 Email
Author 10 Name
Author 10 Email
Subject of Abstract*
If you selected "Other", please describe below:
Presentation/Poster Title*
Will you have multiple presenters?*
Please enter the names and email addresses of other presenters.
Abstract

Please enter your abstract below. Once submitted, your abstract cannot be altered in any way and will be published as typed.
Your abstract will be published in the abstract booklet as it appears below. All abstracts must be formatted as follows (please note that author names do not count against the character limit):

For Research: Title, Authors' names (ex. Smith, JL), Background/Purpose, Methods, Results, Conclusion

For Quality Improvement or Innovation Abstracts: Title, Authors' names (ex. Smith, JL), Background, Intervention/Innovation, Results, Conclusion

For Clinical Case Reports: Title, Authors' names (ex. Smith, JL), Case Description, Conclusion, Clinical Significance
Author Names: Please remember to place the author names in the correct order/in the order they will appear on your poster (e.g. the primary author is listed first, etc.), followed by your abstract text.* Example: Jones K, Silverman VM, ....*
Abstract: Please limit your abstract text to ≤2000 characters (Author names DO NOT count as part of your character limit.). *

0/2080
Agreement and Electronic Signature

I affirm that I have reviewed the application instructions and that the facts set forth here are true and complete. I also acknowledge that my $50.00 abstract fee is required to participate, and that it is non-refundable in the circumstance that I am unable to attend. I understand that an email has been sent to each of the authors listed with notification of my submission. If selected, I understand that I must register and be present at the AMWA annual meeting in Philadelphia, March 23-26, 2023.
Signature (Electronic)*

Submission fee $50.00, non-refundable. Your submission will only be considered if the submission fee is paid.

DocPreneur Abstract Submission Fee- Annual Meeting 2023$50.00

Total $0.00

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AMWA Innovation Challenge 1.0

Presenter Information

Abstract

Agreement and Electronic Signature