Emergency Medicine Conference
11th Annual
Lake Buena Vista, FL
May 3-7, 2015
Register Today

Abstract Submission Form

 Abstract Submission Form

Contact the SEMPA office with any questions or concerns regarding this process at dmcnett@sempa.org or 877-297-7594 ext 3229.

Submitting Author:

First Name:   Middle Initial:  

Last Name:   Credentials (PA-C, PhD, etc.):

Contact Phone:   Contact Email:  

Member of SEMPA:


Address Line 1: 

Address Line 2: 

City:  State: 

Zip/Postal Code:   Country:  

This abstract is best characterized as: (select one)

 
Abstract Title:  

Abstract: (Maximum of 2000 characters including spaces.)

 

 Author Information

Author information will appear in the order in which it is submitted on this form.

Author 01

First Name:   Middle Initial:

Last Name:   Credentials (PA-C, PhD, etc.):  

Current Institution:

If Student, Current PA/Medical School:

If Fellow or Resident, Current PA Residency or Fellowship Program:

Author 02

First Name:   Middle Initial:

Last Name:   Credentials (PA-C, PhD, etc.):

Current Institution:

If Student, Current PA/Medical School:

If Fellow or Resident, Current PA Residency or Fellowship Program:

Author 03

First Name:   Middle Initial:

Last Name:   Credentials (PA-C, PhD, etc.):

Current Institution:

If Student, Current PA/Medical School:

If Fellow or Resident, Current PA Residency or Fellowship Program:

Author 04

First Name:   Middle Initial:

Last Name:   Credentials (PA-C, PhD, etc.):

Current Institution:

If Student, Current PA/Medical School:

If Fellow or Resident, Current PA Residency or Fellowship Program:

Author 05

First Name:   Middle Initial:

Last Name:   Credentials (PA-C, PhD, etc.):

Current Institution:

If Student, Current PA/Medical School:

If Fellow or Resident, Current PA Residency or Fellowship Program:

Author 06

First Name:   Middle Initial:

Last Name:   Credentials (PA-C, PhD, etc.):

Current Institution:

If Student, Current PA/Medical School:

If Fellow or Resident, Current PA Residency or Fellowship Program:

Author 07

First Name:   Middle Initial:

Last Name:   Credentials (PA-C, PhD, etc.):

Current Institution:

If Student, Current PA/Medical School:

If Fellow or Resident, Current PA Residency or Fellowship Program:

Author 08

First Name:   Middle Initial:

Last Name:   Credentials (PA-C, PhD, etc.):

Current Institution:

If Student, Current PA/Medical School:

If Fellow or Resident, Current PA Residency or Fellowship Program: 

Click Submit Form to submit your abstract and upload up to 2 images and add additional authors if needed.

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