WIPM 2025 Abstract Submission Form
Submission Deadline: April 8, 2026
Abstract Title
Primary Presenter
Primary Presenter Name
First Name
Last Name
Credentials
Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Co-Presenter
Co-Presenter Name
First Name
Last Name
Credentials
Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Co-Presenter 2
Co-Presenter 2 Name
First Name
Last Name
Credentials
Company
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
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Please attach your abstract which includes: Introduction, Objectives, Materials and Methods, Results, Conclusion, References (Author 1, Author 2, Author 3 et al. Title. Journal Year. Volume: start page-end page), Acknowledgements - please acknowledge any funding source and contributors to the research, Figure and Table Legend. The abstract should be no more than 300 words. References can be separate and will not impact word count. Please attach everything in one file, on separate pages. The uploaded document should be labeled last name.first name of the primary presenter. (ex. Doe.John)
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Are you a Fellow or Resident?
Yes
No
Is this Abstract Industry Sponsored?
Yes
No
Disclosures
Do any of the authors of this abstract have any commercial relationships to disclose? - If yes, please complete the Disclosure of Commercial Relationships.
Yes
No
Is any device or drug required FDA approval identified as an important component of your presentation? - If yes, please complete the FDA Disclosure Form.
Yes
No
Signature
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
By submitting this abstract, the presenting author certifies the following:
The identical abstract has not been submitted to any other meeting. The material has not been accepted for publication before this submission. All the listed presenters have reviewed this abstract and agree to its submission. Upon acceptance, the presenting author accepts the commitment to possibly present the abstract at the WIPM 2026 Conference.
Presenter Biographical Form
This information must be submitted for the Primary Presenter only. Please type the information with your name and credentials exactly as you want them to appear in the published materials.
Name
First Name
Last Name
Credentials
Professional Title
Facility
Work Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Phone Number
Please enter a valid phone number.
Work Fax Number
Please enter a valid phone number.
Mobile Phone Number
Please enter a valid phone number.
Email
example@example.com
Academic Preparation/Institution
Please include Relevant Training and Experience in this Area
Preferred Social Media
Please Select
LinkedIn
Twitter
Instagram
Facebook
Social Handle
Disclosure of Financial Relationships
All authors submitting abstracts for publications are required to disclose any relationships with industry that may direct bearing on relevant subject matter. The primary presenter must disclose any author/presenter who has relevant financial interest or other relationships occurring with the past 12 months with commercial companies or organizations.
Author Name
First Name
Last Name
Company
Company
Company
Company
Board Member/Trustee
Consultant/Advisor
Employee
Investigator
Investment/Stock Options/Shares
Meeting Participant/Lecturer
Owner
Scientific Study/Trial
Other (please specify)
Additional Form if needed
Author Name
First Name
Last Name
Company
Company
Company
Company
Board Member/Trustee
Consultant/Advisor
Employee
Investigator
Investment/Stock Options/Shares
Meeting Participant/Lecturer
Owner
Scientific Study/Trial
Other (please specify)
Additional Form if needed
Author Name
First Name
Last Name
Company
Company
Company
Company
Board Member/Trustee
Consultant/Advisor
Employee
Investigator
Investment/Stock Options/Shares
Meeting Participant/Lecturer
Owner
Scientific Study/Trial
Other (please specify)
Additional Form if needed
Author Name
First Name
Last Name
Company
Company
Company
Company
Board Member/Trustee
Consultant/Advisor
Employee
Investigator
Investment/Stock Options/Shares
Meeting Participant/Lecturer
Owner
Scientific Study/Trial
Other (please specify)
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FDA Disclosure
If a device or drug requiring FDA approval is identified as an important component of your presentation, please list the device/drug and indicate the FDA status as either: Approved, Investigational Device/Drug, Not approved for distribution in the United States.
Device/Drug
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Status
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Device/Drug
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Status
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Device/Drug
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Status
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Device/Drug
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Status
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Device/Drug
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Status
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