Thank you for your interest in submitting scholarly activity for inclusion in the VAFP Scholarly Symposium.  The event is scheduled for Saturday, November 13th.

Please complete the application below and submit your payment via the link at the end of the survey.  Event fees are: AAFP members ($15 fee) and non-members ($25 fee) for medical students, residents, and fellows.

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* 1. Please Enter Your Contact Information Below

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* 2. Type of Scholarly Activity/Project

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* 3. Title of Scholarly Work

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* 4. Abstract (250 words or less)

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* 5. Briefly describe how/why you became interested in pursuing your research project?

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* 6. Lead Presenter/Lead Author

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* 7. Lead Presenter(s) is

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* 9. Additional Author(s)

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* 10. Was an Advisor or Coordinator involved?

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* 11. If an Advisor or Coordinator was involved, please indicate their name and email address.

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* 12. Will you be attending the event in person or virtually?

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