EmailMe Form - UKCPA Submission form for abstracts

Title of Abstract *

Authors full names. Type the main contact author/presenter first

Author(s) Organisation(s)

Main Author/Presenter Name *

First Last

Is the main author/lead presenter a UKCPA member?

If the main author/lead presenter is not a UKCPA member, you will not receive feedback on your abstract

UKCPA membership number (if known)

Main Author/Presenter Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Main Author/Presenter Phone Number *

Main Author/Presenter Mobile Phone Number

Email *

Please do not use a Hotmail email address

Confirm

Have you received any support from any organisation for the submitted work? If yes please give details *

Do you have any financial relationships with any organisations that might have an interest in the submitted work in the previous three years? If yes please give details *

Do you have any other relationships or activities that could appear to have influenced the submitted work? If yes please give details *

Category of work *

research

audit

quality improvement

Please complete by checking the relevant box(es)

Has this work been published before: *

yes

no

Work which has previously been published or presented elsewhere will not be eligible for any award and cannot be published as an abstract.

Please select which conference awards you would like your work to be considered for: *

Best Abstract

Best Poster

Please confirm that you have checked that your entry meets ALL criteria for abstract submission *

yes

Please refer to: http://ukclinicalpharmacy.org/education/awards-programme/ for details

Attach the NAMED copy of your submission here *

Attach the ANONYMOUS copy of your submission here *

This version of your submission will be used for adjudication purposes. Please ensure it is completely anonymised throughout to avoid disqualification. This includes removing the name of the relevant Trust throughout the main body of the paper, as well as the title.