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) Question Title * 3. Lead Presenter/Lead Author Question Title * 4. Additional Author(s) Question Title * 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 MS1 MS2 MS3 MS4 PGY-1 PGY-2 PGY-3 PGY-4 PGY-5 Other (please specify) Question Title * 8. Was an Advisor or Coordinator involved? Yes No Question Title * 9. If an Advisor or Coordinator was involved, please indicate their name and email address. Name(s) Email(s) Question Title * 10. Onsite Contact Information Name * Institution Email Address * Phone Number Done