CCR West 2023 NYRIF - FPS Abstract Submission

CCR WEST 2023 NYRIF - FPS Abstract Submission

Complete this form to submit abstracts for NYRIF - FPS.
Are you submitting to NYRIF - FPS Poster Session?
NYRIF submissions is for Fellows and Residents only.
Abstract Presenter Name

First NameLast Name
Abstract Presenter Email
example@example.com
Total Abstracts Submitting
Maximum of two abstracts allowed per presenter.
Upload your CV

PDF, .DOC, .DOCX,
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UPLOAD YOUR CLINICAL AND/OR BASIC RESEARCH BASED ABSTRACT SUBMISSION BELOW FOR APPROVAL. ABSTRACTS WILL BE APPROVED VIA EMAIL, SHOWCASED AT CCR AND INCLUDED ON THE USB DRIVES PROVIDED TO ATTENDEES.
Abstract #1 Title
This title will be used in all publications.
Abstract #1 Category.
Has Abstract #1 been previously peer-reviewed?
I acknowledge that I have included a disclosure statement in Abstract #1.
Please upload Abstract #1.

.DOC or .DOCX format.
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Abstract #2 Title
Complete if you are submitting a second abstract. This title will be used in all publications.
Abstract #2 Category.
Complete if you are submitting a second abstract.
Has Abstract #2 been previously peer-reviewed?
Complete if you are submitting a second abstract.
I acknowledge that I have included a disclosure statement in Abstract #2.
Complete if you are submitting a second abstract.
Please upload Abstract #2.

.DOC, .DOCX format. Upload if you are submitting a second abstract.
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REQUIRED FORMS for Abstract Submission

Congress of Clinical Rheumatology West 2023
EXPENSE DECLARATION: IF YOU ARE A FELLOW OR RESIDENT PHYSICIAN PARTICIPATING IN THE NYRIF FELLOWS SESSION, DO YOU DECLARE TO ACCEPT THE AWARD STIPEND FOR THE INTENDED PURPOSE OF COVERING YOUR TRAVEL AND ATTENDANCE COSTS FOR PARTICIPATION AT CCR? IF YOU ARE A GOVERNMENT EMPLOYEE PLEASE CHOOSE N/A.
RECORDING OF SESSIONS: AS A PARTICIPANT IN THE NYRIF FELLOWS POSTER SESSION AND/OR CCR POSTER SESSION, I HEREBY GRANT A&R EDUCATIONAL GROUP, LLC AN IRREVOCABLE, NON-EXCLUSIVE, ROYALTY-FREE, WORLDWIDE RIGHT AND LICENSE (BUT NOT THE OBLIGATION) TO RECORD THE AFOREMENTIONED PRESENTATION(S) AND, IN ITS SOLE DISCRETION, MAKE THE RECORDING AVAILABLE FOR PURCHASE DURING THE MEETING AND AFTER FOR AS LONG AS THE INFORMATION IN THE PRESENTATION REMAINS CURRENT. THE PROCEEDS FROM THESE SALES WILL BE USED TO COVER THE COSTS OF THE MEETING AND VIDEO PRODUCTION COSTS.
RECORDING OF SESSIONS: I UNDERSTAND AND AGREE THAT I (THE UNDERSIGNED) RETAIN COPYRIGHT IN THE WORK AND RETAIN ALL RIGHTS.*
IN GRANTING THIS PERMISSION, I ACKNOWLEDGE AND AGREE THAT A&R EDUCATIONAL GROUP, LLC SHALL BE UNDER NO OBLIGATION TO PAY ME FOR THE PERMISSION (OTHER THAN MY AGREED UPON HONORARIUM) THAT I HAVE GRANTED TO A&R EDUCATIONAL GROUP, LLC TO RECORD, COPY OR TO DISTRIBUTE THE PRESENTATION AS SET FORTH ABOVE. A&R EDUCATIONAL GROUP, LLC AGREES TO PROVIDE ME WITH APPROPRIATE ACKNOWLEDGMENT FOR MY PRESENTATION AND I AUTHORIZE A&R EDUCATIONAL GROUP, LLC TO USE MY NAME, LIKENESS AND BIOGRAPHICAL MATERIAL DURING AND AFTER THE PRESENTATION TO ANNOUNCE AND PUBLICIZE ANY USE OF THE RECORDING.

CONFLICT OF INTEREST DECLARATION

Congress of Clinical Rheumatology West 2023
IN COMPLIANCE WITH THE ACCME STANDARDS FOR COMMERCIAL SUPPORT OF CONTINUING MEDICAL EDUCATION, IT IS THE POLICY OF ACADEMIC CME TO ENSURE BALANCE, INDEPENDENCE, OBJECTIVITY, AND SCIENTIFIC RIGOR IN ALL SPONSORED ACTIVITIES. ALL PERSONS INVOLVED IN THE PLANNING, AND ALL FACULTY PRESENTERS (INCLUDING MODERATORS, AUTHORS AND EDITORS) ARE EXPECTED TO DISCLOSE RELEVANT FINANCIAL RELATIONSHIPS DESCRIBED BELOW. FAILURE OR REFUSAL TO DISCLOSE WILL PROHIBIT PARTICIPATION IN THE PLANNING OF AND/OR PRESENTING DURING THE ACTIVITY.
DURING THE PAST 12 MONTHS, HAVE YOU OR YOUR SPOUSE/PARTNER HAD A PERSONAL FINANCIAL RELATIONSHIP WITH ANY ENTITY PRODUCING, MARKETING, RE-SELLING, OR DISTRIBUTING HEALTH CARE GOODS OR SERVICES CONSUMED BY, OR USED ON, PATIENTS.
IF YES, LIST COMMERCIAL INTERESTS:
Example: "Company X"
IF YES, WHAT WAS YOUR ROLE IN THE NATURE OF RELEVANT FINANCIAL RELATIONSHIP?
Example: "Speaker"
IF YES, WHAT WAS RECEIVED IN THE NATURE OF RELEVANT FINANCIAL RELATIONSHIP (EX: SALARY, HONORARIUM, ETC.)?
NOTE: THE AMOUNT RECEIVED IS NOT REQUIRED. Example: "Honorarium"
BY SIGNING BELOW, I ATTEST TO THE FOLLOWING STATEMENTS:
PRESENTERS: I WILL SUPPORT MY PRESENTATION AND CLINICAL RECOMMENDATIONS WITH THE BEST EVIDENCE AVAILABLE FROM ALL SOURCES. I WILL NOT MAKE ANY CLINICAL RECOMMENDATIONS REGARDING PRODUCTS OR SERVICES. I WILL NOT INCLUDE ANY ADVERTISING, TRADE NAMES, COMPANY LOGOS OR PRODUCT-GROUP MESSAGES IN MY EDUCATIONAL MATERIALS. IF IT IS NECESSARY TO USE A TRADE NAME, THEN THOSE OF SEVERAL COMPANIES WILL BE USED. I WILL PROVIDE MY PRESENTATION AND MATERIALS IN ADVANCE FOR PEER REVIEW IF REQUESTED BY ACADEMIC CME. I WILL NOT USE ANY IMAGES WITHOUT PERMISSION. I WILL COMPLY WITH REQUIREMENTS ASSOCIATED WITH PROTECTED HEALTH INFORMATION UNDER THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA). IF MY PRESENTATION PERTAINS TO PATIENT TREATMENT, I WILL PROTECT THE PRIVACY OF PATIENTS DISCUSSED IN MY PRESENTATION(S). I WILL OBTAIN WRITTEN AUTHORIZATION FROM THE PATIENT AND REMOVE ANY IDENTIFIABLE IMAGES OR PATIENT RECORDS FROM MY PRESENTATION.
I WILL UPHOLD ACADEMIC STANDARDS TO INSURE BALANCE, INDEPENDENCE, OBJECTIVITY, AND SCIENTIFIC RIGOR IN MY ROLE IN THE PLANNING, DEVELOPMENT OR PRESENTATION OF THIS CME ACTIVITY AND I WILL SUPPORT CONTENT AND CLINICAL RECOMMENDATIONS WITH THE BEST EVIDENCE AVAILABLE FROM ALL SOURCES. I AGREE TO COMPLY WITH THE ACCME STANDARDS FOR COMMERCIAL SUPPORT OF CONTINUING MEDICAL EDUCATION AS WELL AS REQUIREMENTS TO PROTECT HEALTH INFORMATION UNDER THE HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT OF 1996 (HIPAA).
THE PARTIES AGREE THAT ANY FORM OF ELECTRONIC SIGNATURE, INCLUDING BUT NOT LIMITED TO SIGNATURES VIA FACSIMILE, SCANNING, OR ELECTRONIC MAIL, MAY SUBSTITUTE FOR THE ORIGINAL SIGNATURE AND SHALL HAVE THE SAME LEGAL EFFECT AS THE ORIGINAL SIGNATURE.
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CCR WEST 2023 NYRIF - FPS Abstract Submission

REQUIRED FORMS for Abstract Submission

CONFLICT OF INTEREST DECLARATION