Abstract Submission Form Title of Abstract*Please type or copy your abstract in the box provided. Limit your submission to 450 words or less. Type single-spaced. For electronic submission, you do not need to stay within the borders. The abstract form does not accept graphs, charts, tables, etc.Please Check One. First Author is:* Student Resident Chief Resident Fellow General Classification*Case ReportResearch StudyName*Email Address* Medical School / Training Program*Mailing Address*City*State*- Select a State -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code*Mobile Phone*Co-Author(s)Level of Medical Training as of April 2017Medical Student Year 1Medical Student Year 2Medical Student Year 3Medical Student Year 4Resident PGY1Resident PGY2Resident PGY3Resident PGY4FellowAdditional Requirements An Author Disclosure and Copyright Agreement Form MUST be included with each submission. ALL authors must sign the form and submit it by January 31, 2017. Questions If you have questions about the Abstract Competition, please contact Lisa Nash via email at email@example.com.