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Osseo Conex Form

Complaint Request

Abstract Submission

  1. 1. Applicant's name
    Last name,first name - eg. Smith, John *
    Please enter applicants name
  2. 2. Hospital/Institution *
    Please enter hospital institution
  3. 3. Preferred email address *
    Please enter email address
  4. 4. Preferred mailing address *
    Please enter mailing address
  5. 5. Preferred phone number *
    Please enter phone number
  6. 6. Declaration of Interest
    Please choose one *




    Please enter declaration of interest

  7. Section Two: Abstract Details

  8. 7. Title of project
    In CAPITALS *
    Please enter title of project
  9. 8. Author(s) / Presenter(s)
    Surname and initials only - eg Smith J Y. Presenter's name in CAPITALS
    Do not include titles, degrees or awards     *
    Please enter authors name
  10. 9. Are you an invited speaker? *
    Please enter invite type
  11. 10. Presenter's Biography
    To be used in Session Chairman's introduction *
    Invalid Input
  12. 11. Institution(s)
    1-4 centres where the work originated
    Give only institution name and city - eg Westmead Hospital, Sydney     *
    Please enter institution
  13. 12. Paper Type *
    Please enter paper type

  14. Poster

    13. Is the work suitable for a poster presentation? *
    Please enter poster presentation status
  15. 14. Would you accept a poster position if the application for podium presentation is not successful? *
    Please choose poster position
  16. 15. Presentation
    Please choose the category you would like to present in: *
    Please choose category to present in
  17. 16. Body of Abstract
    Maximum 400 words, excluding headings but including references
    Do not include graphs or diagrams
    Use abbreviations only for common terms; for uncommon terms give abbreviation in brackets after first full use of the term.     *
    Please enter body of abstract
  18. 17. Confirm wordcount - must not exceed 400 words
    Body of abstract only, excluding heading and including references *
    Please confirm wordcount
  19. 18. Recording
    All presentations will be recorded for publication either on DVD or on the internet, for educational purposes only, unless you choose to exclude your presentation.
    Do you consent to the recording of your presentation being published? *
    Please fill in consent to presentation publishing
  20. Security Code *
    Security Code
    Invalid Input

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