Resident and Student Poster Competition

CONTACT INFORMATION:

Please complete the information below.

Title of Poster: *

AAFP ID#: *

First Name: *

Last Name: *

Designations (MD, DO, MPH, etc):

Address: *

Address (line 2):

City: *

State: *

Zip Code: *

Cell Phone Number: *

Email Address: *

Member Type: *

If you are a resident, please list your residency program and program year.

If you are a student, please list your medical school and year.

File Upload:

Please upload the following documents:

Bio: Document should contain 1,200 characters or less. *

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Professional Photo: Headshot should be at least 400px wide by 600px tall in jpeg, tiff, or pdf format *

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Authors

Is there more than one author? *

Yes

No

If you answered yes, please list the author names.

Full Abstract Information:

Category *

Introduction: Subject, purpose, and relevance of the submission to family medicine *

Background information: Objective, setting, participants *

Relevant Literature: focused, relevant and supporting claims made. Please limit to 1-2 sentences that highlight the most important literature *

Interventions/Treatment/Project Plan *

Results/Outcome (If project is in process, explain results/outcomes anticipated) *

Conclusions: Summary, including implications for family medicine practice, teaching, and/or impact on community. *

References: May use a QR code *

* If using a QR code, please put in box "See QR code below"*

If using a QR code, upload here:

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Institutional Review Board:

Sponsoring institution IRB requirements for the submitting program’s institution or school must be followed and must accompany the submission. Documentation of approval or exemption status should be initiated prior to abstract submission. Documentation of IRB status or program requirements must accompany the submission. Please indicate your program’s IRB requirements and status by responding to the following questions (Not included in word limit of abstract):

IRB approval required by my institution: *

Yes

No

IRB approval *

Completed

In Process

Not applicable

IRB exemption granted *

Yes

No

Not applicable

Pending

Please upload documentation of IRB status or program requirements here:

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Poster Competiton Abstract Submission Form

CONTACT INFORMATION:

File Upload:

Authors

Full Abstract Information:

Institutional Review Board:

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