VAFP Application for Scholarly Symposium

Thank you for your interest in submitting scholarly activity for inclusion in the VAFP Scholarly Symposium. The event is scheduled for Saturday, November 7th.

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.

Question Title

* 1. Type of Scholarly Activity/Project

Oral Presentation on Completed Scholarly Activity

Oral Presentation on Work in Progress

Poster on Completed Scholarly Activity

Poster on Work in Progress

Question Title

* 2. Abstract (250 words or less)

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* 3. Lead Presenter/Lead Author

Question Title

* 4. Additional Author(s)

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* 5. Affiliation (Medical School/Residency Program/Organization)

Question Title

* 6. Lead Presenter(s) is

Medical Student

Resident

Fellow

Question Title

* 7. Lead Presenter(s) is

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* 8. Was an Advisor or Coordinator involved?

Yes

Question Title

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

Name(s)

Email(s)

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* 10. Onsite Contact Information

Name *

Institution

Email Address *

Phone Number