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Western Section AUA
Maui 2018 Abstract Submission Form
ABSTRACT DEADLINE: JUNE 10, 2018
IMPORTANT:
If changes are made after submitting the abstract, please
do not
submit another form. Instead, email the changes to
abstracts@wsaua.org
with the paper title.
STEP 1: UPDATE YOUR AUA DISCLOSURE
You will need your AUA ID and password. Even if no changes, you must indicate that in your disclosure. Abstracts submitted without an updated disclosure WILL NOT BE CONSIDERED FOR THE PROGRAM.
If you have do not have an AUA ID number, one will be assigned to you upon request -
just email us
CLICK HERE TO SUBMIT A DISCLOSURE
STEP 2: ABSTRACT INFORMATION
Paper Title: (Type in Upper & Lower case. NOT ALL CAPS)
*
Select Topic of Choice:
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Bladder/Urethra
Calculi
Neurourology
Kidney
Pediatrics
Sexual Medicine
Incontinence/Pelvic Floor
Prostate
Testis
Ureter
How I Do It
Health Policy Essay
History Essay
Resident Essay
Physician Essay
Select Presentation Option:
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🛈
Podium or Poster
Poster only
Video
Round Table
Video file length in minutes:
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🛈
Upload Abstract
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Upload Essay
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Please select one if submitting an essay for the one of 4 competitions:
Resident Essay Contest
Physician Essay Contest
Health Policy Essay Contest
History Essay Contest
Note: Essay manuscript is due by June 10 in addition to abstract
Please check one if applicable:
Young urologist (within 5 yrs post training)
Resident
For Residents, please state year/stage of training and place.
Are you the participant in an on-going research project?
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Yes
No
Is this an original work of yours with advisor(s)?
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Yes
No
Will you be the first author on the manuscript when it is submitted for publication?
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Yes
No
Does your talk involve General X-Ray, CT Safety or Fluoroscopy?
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Yes
No
What percentage of your talk is on General X-Ray (best estimate):
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What percentage of General X-Ray portion is dedicated to Fluoroscopy:
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What percentage of General X-Ray portion is dedicated to CT Safety:
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______________________________________________________________________________________
Has this Paper Been:
Presented at any meeting?
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Yes
No
Previously published?
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Yes
No
Submitted for publication?
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Yes
No
Scheduled for presentation prior to this meeting?
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Yes
No
Provided with funding?
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Yes
No
Please type in company / entity name(s) that provided funding:
*
🛈
STEP 3: CONTACT INFORMATION
First Name
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Middle
Last Name
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Degree (MD, Ph.D)
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Organization
Address
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City
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State or Province
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Country
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Zip Code
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Best Phone Number (in case email fails)
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Email Address (for confirmation)
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Please list principal author first and all co-authors & their degrees.
DO NOT USE RETURN KEY
.
For example: John Doe, MD, Jane Doe, MD
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AUA Member?
*
Yes
No
AUA ID #
FOR NON-AUA MEMBERS, Indicate Sponsor Name:
Comments:
______________________________________________________________________________________
AUA DISCLOSURE
*
I confirm that I submitted my AUA disclosure.
REGISTER TO PRESENT
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I understand there is no fee to submit an abstract, however, in order to participate in the meeting and present, authors must register for the meeting.
TERMS AND POLICIES
(
click to read
)
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I confirm that the information I have provided is complete and accurate and I agree to the terms and policies.