Abstract Submission Form by oqp13905

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									                                           Abstract
                                           Submission Form
                                           February 5–6, 2010 • DoubleTree Paradise Valley • Scottsdale, Arizona
                                           www.communityonc.com


Title of the abstract:




Corresponding author:


First name                             Middle initial   Last name                                 Degree



Title



Institution



Address



City                                                    State                Zip



Telephone                                               Fax



E-mail address


Additional authors:


Name/Degree                                             Institution



Name/Degree                                             Institution



Name/Degree                                             Institution



Name/Degree                                             Institution


                      Please complete page 1 and page 2 of the Abstract Submission Form.
                 Send your submission by e-mail to r.gould@elsevier.com or fax to 631-424-8905.                    1
                                                 Abstract
                                                 Submission Form
                                                 February 5–6, 2010 • DoubleTree Paradise Valley • Scottsdale, Arizona
                                                 www.communityonc.com


Title of the abstract:




Category: (please select the most appropriate category for this abstract)

    Bench to Bedside
    Challenging Cases/Rare Cancers
    How I Treat It
    Managing Side Effects
    Psychosocial Oncology
    Oncology Genetics
    Quality Care
    Other

   Does this abstract represent an encore presentation of the data?
   If so, please send a separate e-mail to explain where and when the material was originally presented.


Young Investigator Award:
The purpose of the Community Oncology Conference Young Investigator Award is to recognize the         Please check the box below
professional development of clinicians who are pursuing research and offering care in the commu-      if the corresponding author
nity oncology setting. Awards for outstanding abstracts will be announced at the meeting.             of this abstract qualifies as a
                                                                                                      Young Investigator according
To be considered a Young Investigator, an author must meet the following criteria:
                                                                                                      to the criteria listed at left.
1. Must be 40 years or younger as of the start of the meeting (February 5, 2010);
2. Must have received a graduate degree (MD, PhD, MSN, PA, MPH, MSc, PharmD, etc);
3. Must have fewer than 5 years of research/clinical experience as of the start of the meeting.



Permission:
With my signature below, I warrant that the material presented in this abstract is original. I understand that abstracts accepted for
presentation at the Fifth Annual Community Oncology Conference will be published in a future issue of Community Oncology and
will be available for viewing online at www.CommunityOncology.net.




Corresponding author name                                                                 Date



                       Please complete page 1 and page 2 of the Abstract Submission Form.
                  Send your submission by e-mail to r.gould@elsevier.com or fax to 631-424-8905.                                        2

								
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