Fellowship Research Award / Margherio Award

To be considered for the above awards you must meet the above guidelines.

I would like my abstract considered for the above awards:  Yes     No

Note: If you are not accepted for an award, please indicate below if you still wish to have your abstract considered for the meeting or if you wish to withdraw your abstract submission.

Withdraw my abstract if I don't receive an award

Consider my abstract regardless of whether I receive an award

Required part of Form

Note: Fields marked with an * are required.

NOTE: If you click on either "Non-member" or "physician in training", you MUST indicate the sponsoring member's name below

Sponsoring Member:

Presenter Information

Presenter:

 Member   Non-member guest    physician-in-training *

First Name:

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Last Name:

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Degree(s):

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Address:

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City: *

  State/Prov.: *

Postal/Zip: *

      Country: *

Phone: *

          Fax:

Email:

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Co-Authors

Proposed Paper or Poster

Please indicate whether you are submitting for a paper or poster.

 Paper or Poster       Paper only or withdraw      Poster only or withdraw

Please download the Financial Disclosure Information. This form must be completed, signed and returned to the Retina Society or abstract cannot be considered.
Please Fax or mail to: Retina Society, PO Box 8429, Boston, MA, 02114, 617-367-4908 fax.

Paper Title
Your title should communicate the presentation content and capture the reader's interest.
NOTE: Please use Title Case eg. This is the Title of this Paper. Please also include complete technical terms with abbreviations in brackets ().

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Abstract
Your abstract should include 4 sections: Purpose, Methods, Results and Conclusions. Please copy and paste the 4 sections into the 4 separate boxes below. NOTE: Please separate paragraphs by hitting the "Enter" key twice.
Purpose
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Methods

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Results

 *

Conclusions

 *

If you are experiencing any problems with the form please contact terry@x-cd.com