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Conferences & Activities > 2010 Annual Meeting & Endo Expo 2010 - Sep 2010 - New York, NY


ABSTRACT SUBMISSION FORM
19th SLS Annual Meeting and Endo Expo 2010
September 1-4, 2010
Sheraton New York Hotel & Towers
New York, New York, USA

DEADLINE FOR ABSTRACT SUBMISSION FOR PUBLICATION :  FEBRUARY 1, 2010

INSTRUCTIONS:

1. Review the Guidelines for Abstracts before submitting this form. Your submission may not be reviewed if it exceeds the guidelines. Complete your submission by February 1, 2010 to be eligible for publication. Submissions made after February 1, 2010 may be accepted for presentation but will not be published.

2. Fill out a separate abstract submission form for each presentation. No more than two abstracts with the same first author may be submitted.

3. For all types of submissions, paste your abstract text (250 words or less) into the body of an email (no attachments please) addressed to Abstracts@SLS.org with the subject line to read Abstract: Your Last Name, Your First Name. Within the body of the email also include: the abstract title, authors' names with degrees, and hospital or institution affiliation. Send a separate email for each abstract submitted.

3a. For video submissions: In addition to emailing your abstract as outlined above, you must forward five (5) copies of your video on CD or DVD in MPEG or Quicktime format (wmv, avi, and mov files are also accepted), along with a printed copy of your abstract and a printed copy of the completed Abstract Submission Form to: Abstract Coordinator, SLS, 7330 SW 62 Place Suite 410, Miami FL 33143 USA. For further information contact SLS via telephone: (305) 665-9959 or (800) 446-2659 or via email at  Abstracts@SLS.org.

3b. For e-poster submissions: In addition to emailing your abstract as outlined above, you must download and complete the SLS E-Poster PowerPoint Template.

4. After completing this form print a copy for your records, then click the SUBMIT button at the end.


Conference Registration Form and Fees are required by July 1, 2010 for presenters of accepted submissions to be listed in the program.

For further assistance contact SLS via telephone: (305) 665-9959 or via email at Abstracts@SLS.org

 
PRINCIPAL PRESENTER INFORMATION:  
First Name: *  
 
Middle Name/Initial:  
 
Last Name: *  
 
Degree: *
 
If Other was chosen- please enter Degree:  
 
Your Specialty (choose one): * General Surgery Gynecology Ob-Gyn Urology Other  
If Other was chosen-please enter Specialty:  
 
Are you a Resident-in-Training?
To qualify as a Resident you must be in training in a U.S. accredited training program or- if outside the U.S.- you must be a Resident-in-Training within the first five years after medical school degree. * 		Yes No  
 
Mailing Address: *  
Mailing Address:  
City: *  
State: *  
Zip/Postal Code: *  
Country: *  
 
Telephone Number - include area code or city and country codes if applicable - please do not enter a plus sign (+) at the beginning of your telephone number : *  
 
Fax Number - include area code or city and country codes if applicable - please do not enter a plus sign (+) at the beginning of your fax number :  
 
E-Mail: *  
 
University/Hospital Affiliation: *  
 
 
NAMES OF ADDITIONAL PRESENTERS/ AUTHORS: Please list Full Name and Degree for each additional author (Example: John Smith MD)  
 
Additional Author/Presenter Name & Degree:  
Additional Author/Presenter Name & Degree:  
Additional Author/Presenter Name & Degree:  
Additional Author/Presenter Name & Degree:  
 
 
Title of Presentation:  
 
Type of Submission: * Scientific Paper Open Forum Video Poster Cyber Cafe Presentation  
 
Choose one ONLY if selection above is Cyber Cafe Presentation: Educational CD Informational CD Web Site Software Other  
 
Submission Category: * General Surgery Gynecology Urology MultiSpecialty Pediatric Surgery Other  
 
If Other was chosen- please enter submission category:  
 
 
Please select the topic that best describes the subject matter of your submission. Choose the topic from those listed within the submission category you have chosen for your abstract. Please select ONE submission category/topic only.  
 
Gyn Laparoscopy (Gynecology) Adhesion Prevention - Abdominal Pelvic Pain Endometriosis - Oncology
Hysterectomy - Myomectomy Innovations - Tricks - Simple Methods - Unusual Cases
Robotics Case Studies Multispecialty Clear Selection 		 
 
Surgical Endoscopy (General Surgery) Adhesion Prevention - Abdominal/Pelvic Pain - NOTES - Colon - Lap Chole
Bariatrics - Anti Reflux - GERD - Hernia Solid Organ - Endocrine
Innovations - Tricks - Simple Methods - Unusual Cases Robotics
Pediatric Surgery Case Studies Multispecialty Clear Selection 		 
 
Endourology (Urology) Nephrectomy - Donor Nephrectomy Oncology Robotics
Innovations - Tricks - Simple Methods - Unusual Cases
Ureteral & Urethral Surgery Abdominal/Pelvic Pain Case Studies
Multispecialty Clear Selection 		 
 
 
Please note that all work submitted must be original and not published or presented before presentation at the conference. All persons whose abstracts are accepted must be paid registrants and present at the conference.  
 
 
Audio/Visual Equipment Needs:  
For presentations that require the use of a computer - participants are required to bring their own laptop computer with VGA output - Mac or PC - with a copy of their presentation on the computer hard drive and a back-up copy on CD-ROM or USB Flash Drive. Projection equipment and microphones will be provided. Please indicate any additional equipment required. Presenters are responsible for any additional costs for special requests.  
DISCLOSURE AFFIDAVIT:  
The Society of Laparoendoscopic Surgeons- in accordance with the Standards of the Accreditation Council for Continuing Medical Education (ACCME) will disclose any significant financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and with any commercial supporters of the activity.  
 
If a continuing medical education program participant and/or spouse/partner is affiliated with or has financial interest in any organizations that may have direct interest in the subject matter of the continuing medical education (CME) program- a conflict of interest may be considered to exist. Such an affiliation or interest does not disqualify a participant from participating- but the prospective audience must be made aware of the relationship in printed and verbal form in advance of the participation. Additionally you must also disclose at the time of participation if your discussion includes the use of products for which they are not labeled (i.e. off label use).  
 
1. Will your participation include discussion of any commercial products or services? * Yes No  
 
2. Within the past 12 months did you and/or your spouse/partner have a significant for profit relationship with the manufacturers of any of the products or providers of any of the services you intend to discuss? If YES- please list the manufacturers and/or providers below and the nature of the relationship. (EXAMPLE - ACCME WEBSITE Mar/07 -“list the names of proprietary entities producing health care goods or services- with the exemption of non-profit or government organizations and non-health care related companies with which you or your spouse/partner have- or have had- a relevant financial relationship within the past 12 months. For this purpose we consider the relevant financial relationships of your spouse or partner that you are aware of to be yours.”) * Yes No  
 
3. My participation DOES/DOES NOT include discussion of the use of products for which they are not labeled ( i.e. off label use) or are still investigational. * Does Does Not  
 
List details of any interests:  
 
Grant/Research: * Yes No List Corporate/Organization for Grant/Research:  
 
Consultant: * Yes No List Corporate(s)/Organization(s) for which you or your co-authors consult:  
 
Speakers Bureau: * Yes No List Corporate(s)/Organization(s) for which you or your co-authors participate in a Speakers Bureau(s):  
 
Stock Shareholder: * Yes No List Corporate(s)/Organization(s) for which you or your co-authors are a Stock Shareholder:  
 
Other Support: * Yes No List Corporate(s)/Organization(s) from which you or your co-authors receive other support:  
 
Type Your Full Name: *  
Enter Todays Date: *  
 
Please review all entries for accuracy and completeness before submitting. Please print before submitting.

Click SUBMIT button only once. 		 
 
 
 
 

 

 
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