Speaker Acceptance Form (2022) – Academy of Spinal Cord Injury Professionals, Inc.

Name *

First

Last

Professional Credentials *

Please enter your professional credentials (MD, RN, etc.) separated by commas. If none, please enter N/A

Email *

Email

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Abstract Title - PLEASE SUBMIT A SEPARATE FORM FOR EACH OF YOUR ABSTRACTS ACCEPTED *

Presentation Mode *

I will present at the ASCIP 2022 Conference
I must respectfully decline to present in 2022

Please let us know why you are declining. *

Permission to record presentation for enduring content. *

I give my permission for ASCIP to record and use my presentation for enduring content.
I do not grant ASCIP permission to record my presentation for enduring content.

I attest that the material in my presentation is original content and that I have permission of the author to use/share/distribute all text, images or other material that may have come from other sources. *

Yes
No

I understand that I must register for the conference in order to present. (Except for notified award speakers.) *

Yes
No

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NOTE: If you have multiple abstracts accepted, please submit a separate form for each abstract.