Online Abstract Submission Form

Commercial Interest-COMPANY NAME

Upload a file to be included with the above submission *

Presenting Author's Mobile Telephone Number *

Methods *

Presenting Author's Complete Mailing Address *

Presenting Author's Academic Degree(s) *

Additional Information

Speaker's Agreement

Agreed: *

Presenting Speaker agrees to the above Speaker's Agreement.

Speaker's Name *

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

PRESENTATION TITLE *

Co-Author(s) *

List references that support the key teaching points. (This must be submitted with your abstract). *

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 Academic/Hospital Affiliations *

Date and time *

Presenting Author *

Results *

Objectives *

Conclusion *

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

Fields marked with (*) are required.
Characters other than English letters, numbers or punctuation cannot be accepted by this website.

Please note the following instructions for the preparation of abstracts:

Abstracts must be written in English and should be structured in such a way as to include: Background, objectives, methods, results and conclusions.
All abbreviations must be defined before being used as an abbreviation in the text.
The content of the abstract is solely the responsibility of the author. The original abstract is reprinted exactly as provided. It is therefore essential that the abstract is correctly typed. Avoid errors, corrections and misspellings.
Abstracts should contain no more than 350 words of text in the recommended font: Times New Roman, size 12 pt. Do NOT use a smaller font size. If including a table in the abstract, please limit the number of words in the body of the abstract to 225. If including a diagram, please ensure that the abstract text together with the diagram do not exceed one page.
Use single spacing.
Title should be typed in UPPER CASE letters in bold and not exceed more than 100 characters. Titles with more than 100 characters will be truncated.
The author/s names and institutions should be in upper and lower case.
Please clearly indicate the name of the presenting author (with a single *), who will be considered the contact person for all correspondence connected with this abstract.
Symbols, tables, graphs or pictures cannot be submitted via this website. You will need to attach an abstract as a separate file with your submission via this website.
No endnotes or frames are acceptable.
Abstracts sent by fax will not be processed or forwarded to the Scientific Committee for review.
PLEASE ATTACH A "WORD" DOCUMENT TO YOUR ONLINE SUBMISSION.

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 two (2) asterisks (**) next to that author(s) name in the heading of the abstract.

What professional practice gap does this abstract address? *

Relevant Financial Relationship

Abstract Information - Background *

Conflict of Interest - Within the past twelve (12) months, I and/or my spouse/partner or immediate family member had a personal financial relationship with the manufacturer of the proct(s) or services that will be presented in this educational activity (planner), or in your presentation (speaker.author). If NO, skip to DECLARATION section. If YES, please list your disclosures and resolutions below (indicate all that apply). Disclosure should include relationssyhips in any amount. *

I DO NOT have a Conflict of Interest or any financial interest or other relationship occurring within the last 12 months.

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).

Contact Us

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

Presenting Author's Personal Details: THE FORM BELOW MUST BE COMPLETED ALONG WITH ALL SUBSQUENT FORMS (Conflict of Interest and Disclosure Forms) FOR ABSTRACTS TO BE REVIEWED AND CONSIDERED BY THE ICA SCIENTIFIC COMMITTEE. (Please see our pull-down menus).

Presenting Author's Email Address *

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

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Type of Presentation *

Oral Presentation

Poster Presentation (Electronic)

Young Investigator Award Competition (Oral)

Presenter's CV *

References Supporting the Abstract *

International College of Angiology

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

EXECUTIVE OFFICE: 161 MORIN DRIVE, JAY, VERMONT 05859-9283 U.S.A.
TELEPHONE: +802.988.4065 FAX: +802.988.4066
ICA EMAIL: denisemrossignol@cs.com or ica@intlcollegeofangiology.org