AHVAP 2025 Annual Conference and Industry Partner Expo Call for Posters

1
Poster Presenter #1* This field is required.
First Name
Last Name
2
Poster Co-Presenter #2
First Name
Last Name
3
Poster Co-Presenter #3
First Name
Last Name
4
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Professional Credentials of Primary Poster Author Contact* This field is required.
6
Facility Name or Employer* This field is required.
7
Facility or Employer Title (i.e. Vice President, Director, etc.) of Primary Poster Author* This field is required.
Huge
Large
Normal
Small
Ok
Ok
8
Phone Number of Primary Poster Author* This field is required.
Please enter a valid phone number.
9
Email of Primary Poster Author* This field is required.
example@example.com
10
Poster Proposed Title* This field is required.This is your proposed poster title that will be used in the official program for the conference.
Huge
Large
Normal
Small
Ok
Ok
11
Poster Proposed Description* This field is required.This description will be used for marketing to conference attendees, so please keep this description to 3-5 sentences that will attract attendees to view your poster.
Huge
Large
Normal
Small
Ok
Ok
12
Describe how your proposed poster is relevant to healthcare value analysis professionals and leaders.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
13
Has this poster been presented at other conferences?* This field is required.
YESNO
14
Does your poster presentation contain data? * This field is required.
YESNO
15
Has your poster presentation been subjected to Institutional Review Board approval (please note that this is not required and is institutional specific)? * This field is required.
YESNO
16
If you have previously presented this poster at another conference, please provide the conference name below.
17
Do you have experience presenting at national professional conferences?* This field is required.
YESNO
18
If you have presented at other national conferences, please list them here.
Huge
Large
Normal
Small
Ok
Ok
19
Please upload your resume/CV in Microsoft Word or Adobe PDF Format.* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
20
Do you have any potential commercial conflicts of interest relevant to this poster?* This field is required.
YESNO
21
Please disclose ALL potentially relevant conflicts of interest here if applicable.
Huge
Large
Normal
Small
Ok
Ok
22
Do you commit to attending the AHVAP 2025 Annual Conference and Industry Partner if your poster is selected for presentation? Please note that poster presenters do not receive conference registration discounts. You are responsible for your registration and travel to the conference. Selected Poster Presenters will be invited to publish their work in the AHVAP Journal of Healthcare Value Analysis.* This field is required.Please select all that apply.
Yes
No
23
Digital SignatureBy digitally signing this submission, you attest that all content contained within it is factual to the best of your knowledge.
Powered by Jotform SignClear
Should be Empty: