2023 Scientific Assembly Poster Application The Arkansas Academy of Family Physicians encourages our medical students and residents to take this opportunity to display their research and network with their peers at the 2023 Annual Scientific Assembly. The Scientific Assembly will be held August 9-12 at the Little Rock Embassy Suites. Posters must be approved by our program committee. We invite student and resident members to submit your poster to be presented at the Scientific Assembly. Eligibility You must be a member of this chapter (as well as everyone listed on this submission form) to participate. Only educational or clinical research that is relevant to family medicine and has been conducted in cooperation with a family medicine residency, or an Arkansas medical student will be eligible to participate. You must make arrangements to bring your poster to the Assembly starting Wednesday, August 9th. and picked up by noon on Saturday, August 12th. The AR AFP cannot be responsible for delivering your poster to the venue or returning them afterward. Specification Requirements of Poster: The AR AFP staff will provide 3x4 foam board and binder clips/push pins for posters to be mounted. We understand that many of you use your posters for other projects within your university or program and will be flexible on size. Academy Staff will be responsible for setting up the display of posters on easels.Top 3 posters will be presented a $100 award! Winners will be announced on Saturday, August 12, 2023.This application must be submitted by July 19, 2023 Question Title * 1. Submitter Status Student Resident Question Title * 2. Title of research Question Title * 3. Primary Author's Name and Professional Designation*Only the primary author will be contacted regarding this submission. Question Title * 4. Medical School or Resident Program Question Title * 5. Contact Information Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 6. Co-Author's Name (if Applicable) and Professional Designation. Also list Co-Authors Status (Student or Resident) and Institution or Resident Program. Question Title * 7. Please list additional collaborators and their professional designation. List them as they should appear on any printed material or event promotional material. Question Title * 8. NAME OF POSTER (list exactly how you would like it to appear on any printed material or promotional material). Question Title * 9. Please list if any financial support was provided and who provided it Question Title * 10. Upload all pages of your poster. (If you max out on the file size you may email them to mary@arkansasafp.org but please submit this form!) PDF, DOC, DOCX, PNG, JPG, JPEG file types only. Choose File Choose File No file chosen Remove File Upload all pages of your poster. (If you max out on the file size you may email them to mary@arkansasafp.org but please submit this form!) Question Title * 11. Authorizing SignatureBy submitting this application, I verify that I understand the conditions and eligibility required. This application is made and entered into by and between the AR AFP and the names in the application on the date set forth on the application. The AR AFP reserves the right to restrict any poster that, in the opinion of the AR AFP, is deemed promotional, commercial, or unethical. The undersigned agrees that this application is effective and an agreement only on its acceptance by the AR AFP. PLEASE TYPE YOUR NAME BELOW: Question Title * 12. Please enter today's date: Date of submission: Date Done