WPTC Abstract Submission Form Submission Form - Online Submission Guidelines

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Thank you for your interest in submitting an abstract to WPTC 2018 in Park City, Utah. The abstract submission date is Monday, April 2, 2018.

All presenters must register for the conference.
Authors and institutions must be omitted from the abstract text. Because of the blinding process used during the review process these rules must be observed. Non-conforming abstracts will NOT be considered.
Abstracts are limited to 200 words and may contain one graphic element (table, photo, chart, etc.).
You may submit more than one abstract.
Abstracts may be accepted for either a podium or poster presentation.
All abstracts must be submitted electronically to be considered.
There is no fee to submit an abstract.
The corresponding author for each abstract will be notified of the status of their abstract via e-mail by Monday, May 7, 2018.
Authors of accepted abstracts are encouraged to submit a manuscript to the review committee for publication in the Journal of Pediatric Surgery. This manuscript should follow the guidelines set forth by the Journal of Pediatric Surgery.

Podium Presentations

Limited to 7 minutes: 4 minutes for presentation and 3 minutes for Q&A

Poster Presentations

Limited to 5 minutes: 3 minutes for oral presentation and 2 minutes for Q&A

Your Name (please include all of your degrees): Example: John Doe, MD, FAAP, as you would like it listed in the syllabus.

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Your Position/Title: (as you would like it listed in the syllabus)

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Your Organization: (as you would like it listed in the syllabus)

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E-mail

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Phone

Address

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Abstract Title, (as you would like it listed in the syllabus):

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Presentation Preferred Format

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Do you wish to withdraw your abstract if we cannot accommodate your preferred format?

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Yes

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Has this abstract been submitted for prior publication or presentation?

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Yes

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If yes, Which journal or meeting?

Abstract Text

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Upload documents, supporting video, images, or text

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Maintenance of Certification Question:

Short answer A

Short answer B

Short answer C

Short answer D

Correct answer?

Please list one or two learning objectives for your presentation as you would like them listed in the syllabus:

For more information about learning objectives please visit: http://www.bu.edu/cme/forms/RSS_forms/tips_for_writing_objectives.pdf

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The potential for conflicts of interest exists when an individual has the ability to control or influence the content of an educational activity and has a financial relationship with a commercial interest,

1. Do you expect to receive anything of value in any form during the current, previous, or next calendar year from a financially interested company?
• An honorarium provided by industry for other presentations and contracted research (even when the check from industry went to the academic institution) is considered commercial support.
• Organizations, which provide clinical service directly to patients, and governmental agencies and their subsidiary facilities, and the NIH, are not considered commercial supporters.

2. What was received: Salary, royalty, intellectual property rights, consulting fee(s), honoraria, ownership interest (e.g., stocks, stock options or other ownership interest), or other financial benefit, excluding any mutual funds stocks and/or blind trusts, which you might hold?

3. Role(s): Serve as an officer or any other position in any financially interested company? Employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and/or other activities (please specify).

Based on your answers to questions 1-3 above is there an actual, potential or perceived conflict of interest for yourself or spouse/partner?

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Yes

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Disclosure of Relevant Financial Relationships -

NOTE: Please disclose all financial relationships with commercial interests (see definition below). Review for relevant COI will be completed by the activity planners and based on current CME/CNE standards of commercial support and in conjunction with Pediatric Education, Practice, and Research department as needed.

Please list the name of the commercial interest - What was received - For What Role/Category. For example: Merck - Honorarium - Speaker

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Statement of Understanding and Signature: "Typing"/entering your name serves as the electronic signature of the individual completing this Biographical/Conflict of Interest Form and attests to the accuracy of the information given above.

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