Registration Form and Poster Information for the 2020 Indiana CTSI Annual Meeting

Please provide the following information to register for the 2020 Indiana CTSI Annual Meeting.

The meeting will be held virtually on Friday September 11, 2020.

If you have any questions, please contact us at info@indianactsi.org.

Prefix

* must provide value

First Name

* must provide value

Last Name

* must provide value

Degree(s)
(MD, PhD, PharmD, JD, RN, etc)

University or Organization

* must provide value

Other University or Organization:

Department

Position

If Other, please specify

* must provide value

Address

City

Zipcode

Would you like to submit a poster for this meeting?

* must provide value

Yes No

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Poster Information: Because the 2020 Indiana CTSI Annual meeting will be held virtually this year, posters need to be submitted via three presentation slides, and a two-minute video presentation.

Poster presentation videos, presentation slides, and an abstract must be submitted no later than 5:00 PM, EDT, on Friday, July 31, 2020, to be considered for presentation at the 2020 Indiana CTSI Annual Meeting. All posters will be considered for presentation including research related to COVID-19 and research addressing racial disparities and health inequities.

Additional details regarding submission of the video presentation will be sent to those proposing to present a poster at the meeting.

Please provide information for who will be presenting this poster if different than the registration information provided above.

Presenter's Prefix

* must provide value

Presenter's First Name

* must provide value

Presenter's Middle Name

Presenter's Last Name

* must provide value

Presenter's University or Organization

* must provide value

Other University or Organization

Presenter's Department

* must provide value

Poster Working Title. Topic, or Theme

* must provide value

Category for poster presentation?

* must provide value

Indiana CTSI Trainee (KL2, TL1, and MedSTAR)

Indiana CTSI Summer Student (including IMPRS, SEED)

Indiana CTSI Supported Researcher

Other

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If Other, please list your category.

Additonal Authors: (please list first name, last name, department and institution; separate all authors by semi-colon)

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Abstract (< 200 words) if available

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Please provide 3 keywords for your research (if available)

Keyword 1

Keyword 2

Keyword 3

Would you like to provide any additional information?

Yes No

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