Abstract Submission

Important Instructions: Fill out the page, then press the button on the bottom to submit the abstract. Print out the page which states, "Your record has been successfully added to the database." This page is a receipt of your abstract submission.

Title:

Topic:

Preferred mode of presentation:

Oral

Poster

Abstract

HINT: You can copy and paste text directly from your word processing program to the text area below after removing line return characters. However, please make sure that your abstract fits its entirety within the box as shown!

Keywords

(Other, not listed)


Presenter
(acceptance letter will be sent here)

-First name
-Last name

-Position
-Department

-Institution
-Email

-Address 1
-Address 2

-City -State

-Country -Postal Code

Area Code- Phone- Fax-

Status of Presenter: Other:

 Second Author
 Third Author

 -First Name

 -First Name

 -Last Name

- Last Name

 -Institution

 -Institution

 -Work Phone

 -Work Phone

 Fourth Author
 Fifth Author

 -First Name

 -First Name

 -Last Name

 - Last Name

  -Institution

  -Institution

  -Work Phone

  -Work Phone

 Sixth Author
 Seventh Author

 -First Name

 -First Name

 -Last Name

 - Last Name

  -Institution

  -Institution

  -Work Phone

  -Work Phone

 

I understand that I may read or present only one paper or poster at each meeting, and that my presentation will be of work not published before the date of presentation.

Send your comments to:
Rhett Drugge, M.D.
Stamford, CT
Internet Dermatology Society
http://telemedicine.org
rdrugge@netaxis.com