MCACS Abstract Acceptance Form

Presentation Acceptance Form

Please fill in the form below.
Do you accept your presentation notification?*

YESNO
What presentation type were you offered in your confirmation email?

Remarkable Case Presentation (6-minutes)Oral Podium Presentation (7-minutes)Quickshot Presentation (3-minutes)ePoster Brekafast Presentation (3-minutes)ePoster Display Only
Abstract # (see confirmation email)*
Presenter Name*

First NameLast Name
Credentials
MD/FACS/PhD/RN etc
Institution/Company*
City, State*
Mobile Phone (only will be used onsite if needed)*

Area CodePhone Number
Email*
Presentation Title Changes (please enter your Presentation Title only if there are changes from what is listed in your confirmation email.)
Does your presentation topic qualify for any of these competitions (open to Residents & Medical Students)?*

Basic Science Trauma AwardFarouck N. Obeid Clinical Trauma Research AwardDanto Cancer Research AwardEducation AwardD. Emerick Szilagi Michigan Vascular AwardKrishna K. & Pamela E. Sawhney Ethics AwardGift of Life Transplantation AwardSuresh “Lata” Mittal Education AwardBest ePosterBest QuickshotBest Remarkable CaseNone of the Above
Should be Empty:

Presentation Acceptance Form