CAP-ACP 2020 ABSTRACT SUBMISSION FORM Presenter First Name* Presenter Last Name* Organization* Email* I am a ...*Select valueResidentMedical StudentGraduate StudentUndergraduate StudentPathologists' AssistantResearch AssistantFellowStaff - Over 7 yrs in practiceJunior Staff - <=7 yrs in PpacticeCetotechnologistTechnologistTechnicianABSTRACT INFORMATIONNOTE: Upload your Abstract Submission file in Word (.doc or .docx) format only.Please make sure all submitted documents are saved and closed on your computer before uploading them to this webpage. Abstract Title* Abstract Category*Select valueBiobankingBiomarkersBone/Soft TissueBreastCardiovascularCytophathologyEducationEndocrineENT PathologyForensicGastrointestinalGenitourinaryGynecologicalHematologicalImagingInfectious DiseasesInformaticsInternational HealthImmunopathologyMolecular PathologyNeoplasiaNephropathologyNeuropathologyOphthalmopathologyPancreaticPerinatal/PediatricsPulmonaryQuality AssuranceRenalSkinTransplant PathologyOtherREMINDER! Abstracts will be automatically rejected if they do not meet the correct format as outlined in the Abstract Submission Guidelines. Upload the Abstract* Preferred Presentation Format*Please select which formatPoster PresentationPlatform PresentationNOTE: Due to the limited time available, not all requests for oral presentation format can be accommodated, and submitters may be offered poster format if accepted.AWARD OPPORTUNITIESYour abstract entry will automatically be considered for all presentation awards for which it is eligible. More information about these awards can be found on the CAP-ACP website at https://www.cap-acp.org/awards.php.DISCLOSURE OF CONFLICT OF INTERESTREMINDER! Before completing this section and submitting your abstract you must review the Disclosure of Conflict of Interest Guidelines as your submission includes your agreement to the disclosure policies. Please Select:*Please be sure to select one of the followingI HAVE/HAD an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.I DO NOT HAVE an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organizationThank you for your disclosure.Speakers who have no involvement with industry should inform the audience that they cannot identify any conflict of interest. ADVISORY BOARD MEMBER?*Please select one of the following within this drop downI am a member of an Advisory Board or equivalent with a commercial organization.I am NOT a member of an Advisory Board or equivalent with a commercial organization. Advisory Board Organization Advisory Board Details SPEAKERS BUREAU MEMBER?*Please select one of the following within this drop downI am a member of a Speakers' BureauI am NOT a member of a member of a Speakers' Bureau Speakers Bureau Organization Speakers Bureau Details REMUNERATION?*Please select one of the following within this drop downI have received payment from a commercial organization (including gifts or other consideration or 'in kind' compensation).I have NOT received payment from a commercial organization (including gifts or other consideration or 'in kind' compensation). Remuneration Organization Remuneration Details RECEIVED GRANTS/HONORARIA?*Please select one of the following within this drop downI have received a grant(s) or an honorarium from a commercial organization.I have NOT received a grant(s) or an honorarium from a commercial organization. Grant/Honorarium Issuer Grant/Honorarium Details PRODUCT PATENT?*Please select one of the following within this drop downI hold a patent for a product referred to in the CME/CPD program or that is marketed by a commercial organization.I DO NOT hold a patent for a product referred to in the CME/CPD program or that is marketed by a commercial organization. Product Patent Organization Product Patent Details INVESTMENTS?*Please select one of the following within this drop downI hold investments in a pharmaceutical organization, medical devices company or communications firm.I DO NOT hold investments in a pharmaceutical organization, medical devices company or communications firm. Investments Organization Investments Details CLINICAL TRIAL INVOLVEMENT?*Please select one of the following within this drop downI am currently participating in or have participated in a clinical trial within the past two years.I AM NOT currently participating in or have participated in a clinical trial within the past two years. Clinical Trial Organization Clinical Trial DetailsI intend to make therapeutic recommendations for Off-Label medications that have not received regulatory approval (i.e. "off-label" use of medication) OFF-LABEL MEDICATIONS*Select Y or NYesNoAcknowledgements and ConfirmationsYou must read and check the three (3) boxes below, as well as enter the captcha, before you will be able to submit this abstract submission and conflict of interest form.I acknowledge that the Royal College requires faculty presentations to be consistent in their use of either generic names, trade names or both generic and trade names during their presentation. Confirmation*Please AcknowledgeYesI confirm that the Conflict of Interest information has been completed by me, the named presenter, and acknowledge that the above information is accurate, and I understand that this information will be publicly available. Conflict of Interest Information*Please AcknowledgeYesI confirm that I have read the Disclosure of Conflict of Interest Guidelines and that all above information is accurate to the best of my knowledge. I acknowledge and understand that this information will be made publicly available. Disclosure of Conflict Of Interest*Please AcknowledgeYesSUBMISSION FEE – FULLY REFUNDABLEAll abstract submissions are charged a $25 refundable submission fee. This fee will be refunded in full after your poster and/or platform is presented at the conference. Submission Fee - enter 25.00 in this field* CAD Verification:Submit My AbstractReset
