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All session chairs, speakers, and abstract presenters are required to complete this survey. 
Please only complete this form ONCE, regardless of the number of times you may be speaking/presenting.

If you are a presenting author of an abstract:

1. You may only be the presenting author on a maximum of TWO (2) abstracts. An alternate presenting author must be selected by the corresponding author if you have exceeded this maximum. Please notify events@mascc.org of any necessary changes.

2. If you are not the presenting author NAMED on the abstract submission, please email events@mascc.org to notify MASCC of this change. Completing this survey does not act as changing the presenting author.

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* 1. Please provide your preferred title (ex. Dr, Prof, Assoc Prof, Mr, Ms, Mrs, Mx) - You may choose to leave this blank

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* 2. Please provide your contact details and mailing address below

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* 3. If applicable, please provide the title(s) of the session(s) you are chairing or speaking in.

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* 4. If applicable, please provide the title(s) of the abstract(s) you are presenting.

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* 5. Please upload your completed Conflict of Interest form in .pdf, .doc, or .docx format (download the form here)

PDF, DOC, DOCX file types only.
Choose File

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* 6. Please upload your profile photo in .jpg or .png format.

PNG, JPG, JPEG file types only.
Choose File

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* 7. Please upload your short biography (3-4 sentences) in .pdf , .doc, or .docx format.

PDF, DOC, DOCX file types only.
Choose File

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* 8. Please provide your designations (ex. MD, PhD, PharmD, etc.)

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* 9. Please provide your work affiliations (e.g. Department, Institution/Hospital)

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