Second
Annual
2003 Summer Institute on Evidence-Based Practice
July 10-12, 2003
Adams Mark Hotel San Antonio, Texas
Abstract
Submission Cover Sheet (oral and poster)
Title
of Abstract/Poster Presentation: _______________________________________________________
______________________________________________________________________________________
This information has been previously disseminated: No___ Yes ___
If presented previously, Where: ____________________________________
When: ____________
Name
of Presenter (first, middle, last): ____________________________________________________
Credentials (e.g., PhD, RN): _________________________
Professional Title: _________________________________ Affiliation:
__________________________
Work
Address:
_________________________
Home
Address:
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Work
Phone:
_________________________
Home
Phone:
_________________________
Fax
# :
_________________________
Email
Address:
_________________________
Name
of Presenter (first, middle, last): ____________________________________________________
Credentials (e.g., PhD, RN): _________________________
Professional Title: _________________________________ Affiliation:
__________________________
Work
Address:
_________________________
Home
Address:
_________________________
_________________________
_________________________
_________________________
_________________________
_________________________
_________________________
Work
Phone:
_________________________
Home
Phone:
_________________________
Fax
# :
_________________________
Email
Address:
_________________________
Use other side
if additional space is required
If selected, I agree to present at the 2003 Summer Institute on
Evidence-Based Practice and I give permission for duplication
of my abstract for inclusion in the Conference syllabus and online
proceedings.