Particle Therapy Co-Operative Group, North America (PTCOG-NA) Abstract Submission

Requirements:

The abstract should include the objectives of the study, methods used, the results obtained and conclusions.
The entire abstract, including title, author(s) and affiliation(s) must be no more than 400 words.

Asterisk (*) indicates a required field.

Abstract Information

Title*

Presenting/Corresponding Author*

Presenting/Corresponding Author Affiliation(s)*

Additional Authors and Affiliation

Author Name		Author Affiliation
Author Name 2		Author Affiliation 2
Author Name 3		Author Affiliation 3
Author Name 4		Author Affiliation 4
Author Name 5		Author Affiliation 5

Abstract (400 word limit)*

Funding Sources (if applicable)

Please indicate whether the abstract is for*

Oral presentation Poster presentation

Conflict of Interest

Describe any financial relationship(s) with relevant commercial interests.

Please complete the disclosure information below regarding financial relationships you and/or your spouse or life partner have held within the past 12 months with a relevant commercial interest. A Relevant Commercial Interest is defined as any "entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients" (ACCME). Please note that ALL support from a relevant commercial interest must be reported. This includes grants given to an institution which manages the funding, IF, the CME planner or speaker is the principal or a named investigator on the grant.

I do not have any relevant financial relationships to disclose.

Consultant fees

Intellectual property rights/patent holder

Ownership interest

Salary, royalty, honoraria

Speaker's bureaus

Supported/contracted research

Other

Contact Information

First Name*

Last Name*

Email Address*

Phone (daytime contact number)

I agree to share this information with St. Jude*
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