FOMA Application

FOMA Student/Intern/Resident/Fellow Scientific Research Poster Competition is open to students, interns, residents and fellows who are members of the FOMA. This is a Peer-Reviewed competition. Submitted abstracts will be reviewed and scored by a panel of judges selected by the FOMA. The top scoring abstracts will be invited to participate in the Poster Competition. Notification will be sent to the first authors.
For Policies and Procedures - click here.

Please fill out the application and submit it by clicking "SUBMIT APPLICATION" button at the bottom of this screen. A confirmation email will be sent to the "First Author's Email" that you enter on this form. Entries received after the deadline will not be accepted.

Poster Category: CASE STUDY EXPERIMENTAL RESEARCH
Competition Category: STUDENT INTERN/RESIDENT/FELLOW

Note - your abstract and poster will be judged by different criteria depending on the research type.
Poster Title: (no surrounding quotation characters)

Characters remaining (max. 240): 240

1ST AUTHOR

First Name:

Last Name:

Degree(s): D.O. M.D. Ph.D. M.P.H.

Degree Other:

Hospital/Institution and Program Name:

Year of Training:

Email address: We'll never share your email with anyone else.

2nd AUTHOR

First Name:

Last Name:

Degree(s): D.O. M.D. Ph.D. M.P.H.

Degree Other:

Hospital/Institution and Program Name:

Year of Training:

3rd AUTHOR

First Name:

Last Name:

Degree(s): D.O. M.D. Ph.D. M.P.H.

Degree Other:

Hospital/Institution and Program Name:

Year of Training:

4th AUTHOR

First Name:

Last Name:

Degree(s): D.O. M.D. Ph.D. M.P.H.

Degree Other:

Hospital/Institution and Program Name:

Year of Training:

5th AUTHOR

First Name:

Last Name:

Degree(s): D.O. M.D. Ph.D. M.P.H.

Degree Other:

Hospital/Institution and Program Name:

Year of Training:

UPLOAD ABSTRACT

Upload the ABSTRACT of your poster/presentation (MsWord only):

ADDITIONAL INFORMATION

Was this research funded by some agency?
No
Yes (If "Yes", please list below)

IRB approval has been:
Received
Not Applicable (If "Not Applicable", why not? Please explain below)

Proprietary Statement/Disclosure

I certify that I have no affiliation/financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the abstract or presentation.

I certify that I have an affiliation/financial involvement with: which has a direct financial interest in the subject matter/materials discussed in the abstract or presentation.

Approval to attend - place a check next to one of the statements corresponding to you:

I am a Resident or a Fellow. I have the approval/permission from my Program Director.
I am M3 or M4. I have the approval/permission from my DME.
I am M1 or M2. I have the permission from the assistant dean of student services.

Signatures

Checking this checkbox is in lieu of the signatures of ALL AUTHORS, verifying that all authors significantly participated in the research product. This is required for the form to be submitted.

Please review this form before submitting.