ONLINE ABSTRACT SUBMISSION FORM

DEADLINE FOR SUBMISSION: FEBRUARY 25, 2008

INSTRUCTIONS

2008 Annual Meeting Information

**ALL FIELD MUST BE FILLED IN**

 

 

NAME OF PRESENTING AUTHOR 


MAILING ADDRESS OF PRESENTING AUTHOR:

Street:

 

City:   State/Province:

 

Zip/Postal Code:    Country:

 

Phone number (include codes)    Fax number


Email Email 2nd:

 

TELL US IF YOU WILL NEED A FORMAL LETTER OF ACCEPTANCE FOR INTERNATIONAL VISA, PERMISSIONS, FLIGHTS, etc.

         No 

       Yes     

        

 

TITLE OF ABSTRACT: 

 

AUTHORS: (Last name then 1 or 2 initials i.e. Dear GD, van Hoesen K)

 

PRIMARY LAB/INSTITUTION NAME & ADDRESS:

 

ABSTRACT TEXT:  (you can paste in a table from MSWord)
 

 

TOPIC FOR PRESENTATION: (select one only)

  • Diving/Decompression Illness: Theory & Mechanisms

  • Carbon Monoxide Poisoning

  • Chamber Safety and Patient Management

  • Wound Healing and Important Adjuncts

  • HBO2 Therapy and Mechanisms

  • Diving/Decompression Illness: Clinical

 

SUBMIT THIS ABSTRACT FOR THE RESIDENTS COMPETITION? (Abstracts eligible for the Residents’/Trainee competition are those to be presented by a medical student, resident, PhD trainee, or fellow.  This individual need not be the lead author, but must present the work at the meeting.)

             No 

             Yes   

         

 

SUBMIT THIS ABSTRACT TO CONCURRENTLY TO THE ASSOCIATES/BNA SESSION? (All accepted abstracts will be included in the conference proceedings and must be presented in poster format.  Associate members of the UHMS or members of the BNA may also be invited to present their work in the Associates/BNA session.)

             No

             Yes   

              

 

KEYWORDS:  (up to 5 that you select, will be used for searches):
 

 

PRESENTATION:

All abstracts must be presented in poster format, without exception.  In addition, presenters may be invited to present an abstract orally in the general meeting, resident’s/trainee competition (if eligible), or in the associates/BNA session (if eligible).

 

If invited, would you be willing to present your abstract orally (check all that apply):

In the general meeting?

       No

      Yes

       

 

In the residents’/trainee competition (if eligible)?

       No

      Yes

       

 

In the associates/BNA session (if eligible)?

       No

      Yes

       

 

 

AUTHORIZATIONS: (you MUST answer yes or no)
a.  Permission to tape is hereby granted (mandatory for oral presentations):    

            No

            Yes

                 
 

b.  The research reported in this abstract follows the Principles embodies by the Declaration of Helsinki (stated in each issue of  the

     Undersea and Hyperbaric Medicine Journal) with approval by the appropriate animal/human use committee, if appropriate:

             No 

             Yes

             

 

DISCLOSURES:

 

a.   Has this work been previously presented or published?  

            No      

         Yes

            

      If yes, please state where and when:

      

 

As an accredited sponsor of CME , the UHMS must ensure balance, independence, objectivity, and scientific rigor in all its directly sponsored or jointly sponsored educational activities.  All speakers and planners participating in CME activities must disclose in writing to the UHMS, and verbally to their audiences, any real or apparent conflict of interest related to the content of their presentation.  Disclosure must never include the use of a trade name or a product-group message.

 

b.  Will your presentation include discussion of any commercial products or services? 

No  

You may inform your audience that you have no relevant financial relationship with commercial interest

Yes   

 

c.  If Yes, do you have a significant financial interest or other relationship* with the manufacturers of any of the products or providers of

    any of the services you intend to discuss?  *Financial relationships can include  employment, management, grants or research support, consultant,

    speaker’s bureau, advisory committees or review panels,  board membership, and other activities from which remuneration is received.  

No   

You may inform your audience that you have no relevant financial relationship with commercial interest

Yes   

List the manufacturer or providers by name and describe the nature of the relationship

Commercial Interest (Manufacturer or Provider)

Nature of Relationship

 

d.  Was your research supported by a grant?

No 
Yes  If yes, Grant Originator

 

e.  I have read and understand my disclosure obligations as outlined above   Yes  Date:

 

CV: Your are required to submit a BRIEF CV for CME purposes with this form

 

 

Abstract Submission Form: WORD      PDF