Trillium 2009 Abstract Submission Form

Identification

Full Name (Required)

Please input your full name.

Title/Degree

Please input your title/degree.

Address

Street (Required)

Please input your street address.

City (Required)

Please input your city.

Province (Required)

Please input your province.

Postal Code (Required)

Please input your postal code.

Contact Information

Phone (w/area code) (Required)

Please input your phone number.

Fax

Please input your fax.

Email address

Please input your email address

Position

Position (Required)

Please choose the position that best describes you.

Physician
Allied Health Professional
Resident/Student
Other

Other

Institutional Affiliations (Required)

Please enter you institutional affiliations.

Topic Area

(check one or more)

Areas (Required)

Clinical

Education

Health Care/Services

Family

Interdisciplinary Care

Other

AV Equipment Required

Please choose the AV Equipment you need for your presentation.

Equipment (Required)

LCD Projector

Overhead Projector

Type of Presentation

Please indicate your type of presentation.

Choices (Required)

Paper (oral)

Poster

Workshop

Abstract

Please input the information for your abstract.

Title (Required)

Presenter(s) (Required)

Authors (Required)

Abstract Text (Required)

Type in (or paste) your abstract (up to 250 words) in this space, then click the "Submit" button at the bottom of the page.

characters remaining

Anita Di Loreto
Administrative Assistant, Research
Department of Family Medicine

McMaster University
75 Frid Street
Hamilton, ON L8P 4M3
Tel: (905) 525-9140 Ext.28509
Fax: (905) 527-4440
Email: dilora@mcmaster.ca

Document Actions