FPS - Absctract Registration

CALL FOR ABSTRACTS Abstracts for case reports presentations should contain the following information:

TITLE: State the title of your presentation.

INTRODUCTION: Briefly describe the case and how it pertains to perfusion practice.

CASE REPORT: Include patient age, gender and other pertinent demographics such as height, weight and body surface area, brief medical history, extracorporeal equipment and circuitry, operative and perfusion procedure, outcome and follow-up (if available).

DISCUSSION: This may include evolution of the technique, history and bibliographic references, expansion of alternative techniques or results, problems, speculations or future suggested approaches.

CONCLUSION: The conclusion should summarize the main points.

QUESTIONS: Submit five questions that can be asked about your presentation at the Case Reports Meeting.

ABSTRACT SUBMISSION FORM Please fill out the form below to submit your electronic abstract for the Case Reports in the Sun Meeting to the Florida Perfusion Society for processing. You will receive email confirmation of receipt within 24-48 of electronic submission.
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone:
Email:

Title:
Introduction:
Case Report:
Discussion:
Conclusion:
Essay:	The Essay is only required if you are a student applying for the Debrah Ann Pacheco Memorial Scholarship.
Question #1:
Question #2:
Question #3:
Question #4:
Question #5:
Scholarship:	I am a perfusion student and would like to be a candidate for the annual Debrah Ann Pacheco Memorial Scholarship Award ($2500.00)
Terms and Conditions: I understand that by submitting this form I am making a commitment to attend and present my case report at the Case Reports Meeting in Tampa Florida. Further, I understand that any material I submit or present may be used for educational or promotional purposes by the Florida Perfusion Society or Perfusion.com, Inc. I hereby grant to the Florida Perfusion Society (FPS) and Perfusion.com, Inc. (PDC): The royalty-free right: To video record my presentation at including all materials prepared or provided by me (collectively, the Program); To reproduce for web casting and/or CD-ROM or DVD as deemed appropriate for educational purposes by FPS or PDC. The right to use my name, voice, photograph, likeness, and biographical information in connection with the exercise of the rights granted in Section 1. The right to produce the materials and distribute the same. With regard to my Program, I hereby assign FPS and PDC the permission to publish, broadcast, transmit or otherwise exhibit all or any part of the presentation. I hereby release and discharge FPS and PDC and their officers, directors, employees, and agents from any and all claims, demands, and causes of action that I may have against them by reason of its exercise of its rights hereunder including, without limitation, any claims based on the right of privacy, the right of publicity, copyright, libel, or slander. I warrant that I am the sole owner of all rights in the Program and that it does not infringe the copyright or other property rights of any third party, that it does not contain any defamatory material or any factual inaccuracies except that which is stated as a matter of opinion, and that I have full power to convey the rights granted herein. Should my presentation contain content that is the property right of others, I will inform FPS and PDC to that content so that it may either be removed or proper copyright notice may be posted. The grant contained herein does not limit the right of the undersigned to make any other use of his or her intellectual property in any other way not inconsistent with the grant contained herein.
I Agree to the Terms and Conditions