Panel Presentation Submission Form

The 2021 Health Care Systems Research Network Conference

HCSRN 2021

Submission Page


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IMPORTANT NOTE: YOU ARE CURRENTLY SUBMITTING FOR A PANEL PRESENTATION. If you are intending to submit for an abstract presentation, click here to access the abstract submission site.

If you have questions or need assistance with your submission at any time, please contact Conference Solutions at HCSRN@ConferenceSolutionsInc.com or 503.244.4294 ext. 1003.

Deadlines and Procedures (* denotes a required field.)
  I have read and agree to the deadlines and procedures.  (*)

Submitter's Contact Information

Please enter your contact information in the fields below. (* denotes a required field.)

First Name: (*)  
Last Name: (*)  
Institution/Organization: (*)  
Phone: (*)  
Email: (*)  
City: (*)  
State/Province: (*)  

List of Presenters

Please enter the complete list of presenters for your submission, in the order in which they will appear in the conference materials. NOTE: You may have a maximum of five (5) presenters, INCLUDING the moderator.

#1
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#2
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#3
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#4
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#5
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#6
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#7
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#8
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#9
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#10
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#11
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#12
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#13
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#14
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#15
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#16
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#17
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#18
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#19
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#20
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#21
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#22
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#23
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#24
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#25
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#26
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#27
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#28
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#29
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)
#30
First Name:(*)
Last Name:(*)
Email:(*)
Institution/Organization:(*)
If "other" was selected, please enter it here:
Country:(*)
State/Province:(*)
State/Province:(*)
City:(*)
Role:(*)
HCSRN Member Status:(*)
Trainee/Student/Fellow Status:(*)

Add Author      Remove Last Author

Title of Panel Presentation Submission

Titles must be entered in title case. This is an Example of Title Case. Titles are limited to 150 characters, including spaces and punctuation and should indicate the content of the submission. Do not use abbreviations (unless obvious to all attendees) or all capitals in the title.

Title (*)   
Word count:
     Max allowed:150      
Topic
Please select the topic area that best fits your panel presentation. (*)

Presentation Summary (*)

Your summary is limited to a maximum of 300 words. If you are cutting-and-pasting from a different document, be sure to review your submission by selecting the Preview Summary button to ensure your pasted text has not been cut-off and/or that any special characters are formatted properly.


Word count:0      Max allowed:300

               


Key Objectives: List 2-3 key objectives which explain how the panel will deliver value to attendees. (200 word max) (*)

Word count:             Max allowed: 200            

Cohesion: Describe how separate parts of the panel interact to create a cohesive whole. (200 word max) (*)

Word count:             Max allowed: 200            


Headshot
Upload a headshot in JPEG/PNG/GIF format for publicity and meeting purposes.

Enter File: (*)

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