INVESTIGATIONAL ABSTRACT APPLICATION FORM
34th Annual John R. Rainey, MD Abstract Competition
January 18 - 20, 2019
Hyatt Regency Lost Pines Resort; Bastrop, TX
Deadline to Submit: Friday, November 2, 2018

First Author Information

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* 1. First Name:

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* 2. Last Name:

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* 3. Credential(s):

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* 4. I am a...

Medical Student

Resident

Fellow

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* 5. Mailing Address:

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* 6. City:

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* 7. State:

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* 8. Zip Code:

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* 9. Phone Number: (XXX) XXX-XXXX

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* 10. Email Address:

Program Information

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* 11. Company/Institution:

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* 12. Program Director:

Abstract Information

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* 13. Category:

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* 14. Abstract Title:

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* 15. Additional Authors:

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* 16. Background: (please limit to 150 words)

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* 17. Materials/Methods: (please limit to 150 words)

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* 18. Results: (please limit to 150 words)

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* 19. Discussion: (please limit to 150 words)

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* 20. File Upload

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File

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* 21. Acknowledgements:

I must register to attend this year's Annual Meeting ($50).

The abstract being submitted lists the individual above as the first author.

The abstract being submitted represents the work performed by the first author listed above.

The abstract being submitted has not been presented at prior national meetings.

That abstract being submitted has been read and approved by my Program Director.

Author Initials: