Online Abstract Submission Form

What professional practice gap does this abstract address? *

ABSTRACT FORM

How will this abstract influence change in competence, performance or patient outcomes? *

Co-Author(s) *

Presenting Author *

Methods *

International College of Angiology

Member, Council for International Organizations of Medical Sciences (CIOMS)

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Executive Office:

International College of Angiology

161 Morin Drive

Jay, Vermont 05859-9283 USA

Tel: +802.988.4065

Fax: +802.988.4066

Email: ica@intlcollegeofangiology.org

Results *

PRESENTATION TITLE *

Off-Label Use *

This presentation DOES NOT include information about product(s) not labeled for use or investigational.

This presentation DOES include information about product(s) not labeled for use or investigational. (See next box for specific information). I understand that I must disclose this information to the audience prior to the presentation.

Presenting Author's Complete Mailing Address *

Presenting Author's Academic Degree(s) *

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Presenting Author's Email Address *

Off-Label Proceedure(s)/Product(s) under investigation are: (please be specific)

Abstract Information - Background *

Conclusion *

Nature of Conflict (be specific) *

Objectives *

Presenting Author's Academic/Hospital Affiliations *

Presenting Author's Telephone Number *

Conflict of Interest *

I DO NOT have a Conflict of Interest

A Conflict of Interest DOES EXIST. I understand that it is necessary that the conflict of interest be identified openly at the beginning of my presentation so that the audience may form their own judgments about the presentation with the full disclosure of the fact of my presentation. (My conflict is listed below).

Type of Presentation *

Oral Presentation

Poster Presentation (Electronic)

Video Presentation

Young Investigator Award Competition (Oral)

ABSTRACT FORM - ONLINE SUBMISSION

Presenting Author's Personal Details: THE FORM BELOW MUST BE COMPLETED ALONG WITH ALL SUBSQUENT FORMS FOR ABSTRACTS (Please see our pull-down menus).ALL NON-FELLOWS OF THE INTERNATIONAL COLLEGE OF ANGIOLOGY MUST SUBMIT AN ABSTRACT PROCESSING FEE WITH YOUR ABSTRACT SUBMISSION IN ORDER FOR YOUR PRESENTATION TO BE CONSIDERED. PLEASE COMPLETE THE SECTION ON ABSTRACT PROCESSING FEES WITHIN THIS SITE.

Please read the Abstract Guidelines page on this site carefully before completing this form.

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ABSTRACT PROCESSING FEE: A one-time non-refundable processing fee of USD $25 must accompany your abstract submission. This applies only to Non-Members of the International College of Angiology. Please see the section on Abstract Processing Fee. Those who are Fellows, Associate/Affiliate Fellows, Members and Students of the ICA are exempt from this fee as part of their membership benefits.

A PDF Abstract Form is available on this website, should you not wish to submit your abstract online.

POLICY STATEMENT

The International College of Angiology requires that audiences at the College's educational programs be informed of a presenter's (moderators, speakers, faculty, authors, contributors and planners) academic and professional affiliations, as well as other commercial relationships relevant to the content of the material that is presented. This policy allows the listener/attendee to be fully informed in evaluating the information being presented. The situations may include but are not limited to 1) stock options or bond holdings in a for-profit corporation or self-directed pension plan, 2) research grants, 3) employment (full or part time), 4) ownership or partnership, 5) consulting fees or other remuneration received by the presenter or his/her immediate family, including support that may be provided to attend the educational meeting, 6) non-remuneration received by the presenter or his/her officer, board member, trustee, or public spokesperson. The disclosure will be shown as an indication (by an *) for those presenters who have stated that a relationship(s) exists relevant to the topic(s) being discussed. Indicate any author(s) who has a possible conflict of interest (see policy statement) by an asterisk (*) next to that author(s) name in the heading of the abstract.