North Texas Chapter of the American College of Surgeons

Online Abstract Submission
Deadline: Friday, November 12, 2010 - Midnight CST

The North Texas Chapter of the American College of Surgeons
50th ANNUAL MEETING
February 18-19, 2011
Cityplace Conference Center
Dallas, Texas

Should you have any questions, please contact NTC-ACS at 913-402-7102 or meetings@ntexas.org

The Program Committee of the North Texas Chapter of the American College of Surgeons requests your participation in the 2011 Annual Meeting. You are invited to submit an abstract on the clinical or laboratory research project of your choice. Abstracts must conform to the instructions below. Accepted abstracts will be published in the Final Program. If your abstract is selected for presentation in the General Session, you may submit a manuscript for consideration of publication in The American Surgeon. All participants will be required to register for the meeting.*

ATTENTION RESIDENTS! A cash prize will be awarded for the best paper submitted and presented by a resident. If the paper is to be considered for the Residents’ Research Award, this must be indicated on the Abstract Form below. A letter from the Program Director stating that the abstract is primarily the work of, and will be presented by, a resident, is required.

The Program Committee looks forward to receiving your abstract by Friday, November 12, 2010. No late submissions will be accepted. Senior authors will be notified regarding the acceptance of their abstract via e-mail by mid-December.

Sincerely,
Christopher Bell, MD
Program Chairman

* There will be no Registration Fee charged to Residents or Medical Students.

North Texas Chapter of American College of Surgeons
5810 W. 140th Terrace
Overland Park, KS 66223
Email: meetings@ntexas.org
Telephone: 913-402-7102
Fax: 913-273-1140
Web: www.ntexas.org

* indicates required field

* Senior Author:

Person to whom all correspondence should be e-mailed.

*First Name
*Last Name
*Institution
*Address (Line 1)
Address (Line 2)
*City
*State
*Zip Code
*Phone
Fax
*Email
*Credentials
*Status	Member Non-member Resident

* Presenter

Full name of author who will present this paper.

Same as above
*First Name
*Last Name
*Institution
Address (Line 1)
Address (Line 2)
*City
*State
Zip Code
*Phone
Fax
*Email
Credentials
*Status	Member Non-member Resident

* Presentation Type:

Oral or Poster Presentation
Oral Presentation Only
Poster Presentation Only

Does this presentation qualify for the RESIDENT RESEARCH AWARD?
Yes No

NOTE: Include letter from Program Chairman stating that abstract is primarily the work of, and will be presented by a resident. This letter must include the abstract title and resident’s full name; letter to be forwarded to the NTC ACS Headquarters listed at the bottom of this page.

* Speaker Disclosure:

DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS Per ACCME regulations, the American College of Surgeons disclosure process must ensure that anyone who is in a position to control the content of the education activity has disclosed to us all relevant financial relationships with any commercial interest as it pertains to the content of the presentation. Should it be determined that a conflict of interest exists as a result of a financial relationship you may have, you will be contacted and methods to resolve the conflict will be discussed with you. In addition, all affirmative disclosures must be revealed by a slide at the beginning of the presentation. Failure or refusal to disclose or the inability to resolve the identified conflict will result in the withdrawal of the invitation to participate. * Please check here as acknowledgement that you have read the terms of disclosure and will comply with these terms, should your abstract be selected for the program. Check One (Required): I do not have any relevant financial relationships with any commercial interests AS IT PERTAINS TO THIS PRESENTATION I do have the following relevant financial relationships to disclose AS IT PERTAINS TO THIS PRESENTATION:
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.
Explain what you or your spouse/partner received (ex: salary, honorarium etc):
Specify your role:
Commercial Interest:
Nature of Relevant Financial Relationship:
If your presentation describes the use of a device, product, or drug that is not FDA approved or the off-label use of an approved device, product, or drug or unapproved usage, it is your responsibility to disclose this information verbally to the learner during your presentation.

* Authors:

Authors' initials precede the last names. Include each author's highest degree, but omit FACS and all punctuation within names. (Example: JD Doe MD, MA Jeffrys PhD, VJ Zannis MD).

* Title:

NOTE: PLEASE USE ALL CAPITAL LETTERS WHEN LISTING ABSTRACT TITLE.
Do NOT use abbreviations or references to authors or institutions. Watch for spelling! How the title is presented here is how it will be printed in meeting materials.
(Sample Title: THIS IS THE TITLE OF OUR ABSTRACT)

* Institution

Please list FULL NAME of Institution. (Note that only ONE will be credited in the program.)

Same as senior author (you must manually fill in the country)
* Name
* City
* State
* Country

* Abstract Copy:

Number of characters left:

Abstract copy must be 3000 characters or less, including spaces, graphs and charts (the character count does NOT include the abstract title or author string). The abstract copy must include the following: Background, Method, Results, Conclusion. Do NOT use highlighting or italics for emphasis. No reference to the authors or the institution should appear within the body of the abstract.

Upload graph or chart
(Only one attachment containing a single table or figure will be permitted)

* Submit:

Your submission acknowledges these general understandings:

Presenters/authors are responsible for all registration and travel expenses associated with attending the meeting.
You will receive an automatic email confirming your abstract submission. If you DO NOT receive this final confirmation, please contact NTC-ACS via email at meetings@ntexas.org or telephone at 913-402-7102.

* I agree with these general understandings.

* What is 6 + 1?
(This is to ensure the form is being submitted by a person, not an automated spamming script.)

Should you have any questions, please contact the NTC ACS Headquarters: