AMWA105 Meeting Abstract Submission Form

AMWA105 Annual Meeting

Abstract Submission Form
The American Medical Women's Association (AMWA) 105th Annual Meeting (#AMWA105) will be held March 26-29, 2020 in Indianapolis, IN. More information about the meeting can be found on our meeting website: https://www.amwa-doc.org/amwa105/. We invite you to submit your poster abstract using this form.

Premedical/medical student poster presentations will be 8PM - 9PM, Friday, March 27, 2020 and 7:30AM - 8:30AM Saturday, March 28, 2020. You will be assigned a specific time at when you receive your decision. Physician and resident/fellow poster presentations will be Saturday, March 28, 2020.

By submitting your abstract to us, you are agreeing that we may distribute your abstract as part of AMWA 105th Annual Meeting content via an online portal or in print.

Posters that align with AMWA’s priority topics are especially encouraged. These include:
- Gender Specific Medicine
- Gender Equity
- Work-Life Issues
- Physician Wellness & Burnout
- Public Health Initiatives: Gun Violence Prevention, Opioid Addition / Pain Management, Human Trafficking, Obesity, Cervical Cancer Eradication, Women’s Health
- Medical Education & Training
Submission Guidelines:
- Each abstract must be submitted using this application form
- Approval must be obtained from ALL authors before the abstract is submitted. A confirmation email will be sent to each author following submission receipt
- One of the authors must be available to present at the conference.
- The abstract must be 2000 characters or less (including spaces, excluding title and author names). No graphics or tables are allowed in the online submission form.
- There is a one-time, non-refundable $45 poster application fee
- Formatting:
  For Research Abstracts: Background/Purpose, Methods, Results, Conclusions
  For Quality Improvement or Innovation Abstracts: Background, Intervention/Innovation, Results, Conclusion
  For Clinical Case Reports: Case Description, Conclusions, Clinical Significance
- Please enter your abstract information as accurately as possible, as it will not be able to be changed after submission of this form.
The deadline for poster abstract submission will be 11:59PM PST, December 15, 2019. Posters after that time will be accepted on a space available basis. Questions? E-mail program@amwa-doc.org
Personal Information
Presenting Author's Name *

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

Area Code Phone Number
Presenting Author's Institution/Affiliation *
Presenting Author's Title
e.g. Assistant Professor at Harvard, Instructor
Country *
Please indicate which category your abstract should be judged in *
Options are: physician, resident/fellow, medical student, graduate student, pre-medical student, other
Which residency or fellowship program you are currently training in?
e,g, Kaiser Permanente Oakland Internal Medicine Residency Program
Are you an AMWA member? *

Yes No
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 publication in the MWIA Conference Abstract Booklet, which may be published online or in print? (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
Type 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.). *

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Agreement and Electronic Signature

By submitting this application, I affirm that I will be available to present at the AMWA105 Meeting. 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 $45.00 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.
Signature (Electronic) *

Abstract submission fee $45.00 per abstract, non-refundable. YOUR ABSTRACT WILL ONLY BE CONSIDERED IF SUBMISSION FEE IS PAID.

Abstract Submission Fee $ 45.00

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AMWA105 Annual Meeting

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