Requirements for the Application Process
[pic]
Kathy Cramer Young Clinician Memorial Scholarship Award
Through a generous donation from the Estate of Kathy Cramer, OTA is pleased to announce a scholarship award for young clinicians. Through the Kathy Cramer Young Clinician Scholarship Award, OTA will sponsor two OTA members for participation in the ORS/OREF/AAOS Young Investigators Workshop.
2016 ORS/OREF/AAOS New Investigator Workshop
Clinical, Translational, and Basic Science Research
WORKSHOP APPLICATION
May 13-14, 2016 ● Jacksonville, FL
Application Deadline: February 1, 2016.
Please email this application and all supporting documents to shozda@
(DO NOT PDF YOUR DOCUMENTS)
►Completed Application
►Letter of Nomination
►NIH Biosketch of the Applicant (Template)
►Profile Page
►Housing/Registration Form (Please note, your credit card will only be charged if your application to attend is accepted)
|First Name | |Last Name | |
|Credentials | |
|Institution | |
|Department | |
|Address 1 | |
|Address 2 | |
|City | |State/Province | |
|Zip/Postal Code | |Country | |
|Email | |Phone# | |
| |
|ADDITIONAL INFORMATION |
|Research Collaborations | |
|OREF Grant Recipient? | YES NO |
| |If yes, what year? |
|Do you plan to submit a grant | YES NO |
|proposal? Accepted grant |If yes, please email your proposal to metoyer@ by February 15, 2016 |
|proposals are K, R01, R03, R 21 | |
|NIH Style Specific Aims Page |REGUIRED! |
| |You must bring NIH style specific aims page of a proposed research grant or one that was just funded that |
| |has not begun. |
2016 ORS/OREF/AAOS New Investigator Workshop
Clinical, Translational, and Basic Science Research
PROFILE PAGE
This page will be published in the workshop’s syllabus
pending your application acceptance.
Photo
Please upload your high resolution photo (minimum 300 dpi)
Double click on the image icon to upload your photo
[pic]
,
First Name Middle Initial Last Name, Degree
Position Title:
Current Institution:
Personal Statement (250-300 words)
Career Goals (250-300 words)
Orthopaedic Areas of Interest
•
•
•
•
•
•
•
•
•
•
[pic]
2016 REGISTRATION / HOUSING FORM
Please return this form to the OTA office by February 1, 2016.
Fax: 847-430-5140 or Email: shozda@
2016 ORS/OREF/AAOS New Investigator Workshop
MEETING DATES: Friday - Saturday, May 13-14, 2016
MEETING SITE: Hyatt Regency Jacksonville – Riverfront
Friday, May 15 8:00 am – 5:30 pm
Saturday, May 16 8:00 am – 3:00 pm
HOUSING SITE: Hyatt Regency Jacksonville – Riverfront, Jacksonville
225 E. Coastline Drive, Jacksonville, FL 32202
Phone: (904) 588-1234
Check-in Time: 3:00pm, Check-out Time: 12:00pm
PARTICIPANT INFORMATION
|YOUR NAME | |
| | |
|EMAIL | |
| | |
|List any food allergies or | |
|indicate if you are a | |
|vegetarian | |
$775 REGISTRATION FEE INCLUDES:
• Housing ( 2 nights: Thursday, May 12 and Friday, May 13)
• Meals provided on Friday, May 13 and Saturday, May 14
• Networking and Collaboration Dinner (Casual)
• Workshop materials
|CREDIT CARD INFORMATION: |
|American Express VISA MasterCard |
| |
|Credit Card #: Exp Date: |
| |
|Print Name of Card Holder: |
| |
|Signature of Card Holder: |
| |
| |
Room rate of $139 will be honored May 11-15 if you plan to arrive early or extend your stay. This room rate excludes of taxes, currently at 14.13%, resort charges, and service charge.
NOTE: Attendee is responsible for incidentals, all spouse/guest expenses, and any extra night(s) at the hotel not related to the workshop
SLEEPING ACCOMMODATIONS
|Arrival Date: |Departure Date: |
| Smoking Single Occupancy King Bed |
|Non-Smoking Double Occupancy Double Bed |
|If ADA (Americans with Disabilities Act) accommodation is desired, please specify: |
| |
| |
All reservations are guaranteed for late arrival (after 6:00 PM) by the Orthopaedic Research Society.
If you request a sleeping room and fail to notify the staff liaison or hotel directly of a cancellation prior to 11:00 AM of the day of arrival, you will be billed for one night’s sleeping room cost by the ORS.
FRIDAY, MAY 13, 2016: NETWORKING & COLLABORATION DINNER
You are invited to the networking and collaboration dinner on Friday evening (6:30pm – 9pm) for all faculty and participants.
I WILL ATTEND I WILL NOT ATTEND
SATURDAY, MAY 14, 2016: WORKING LUNCH, MEETING WITH MENTORS, NETWORKING & COLLABORATION
I WILL ATTEND I WILL NOT ATTEND (I have an early flight)
PLEASE COMPLETE AND RETURN THIS FORM BY FEBRUARY 1, 2016
TO: Barbara Shozda
FAX: 847/430-5140 E-MAIL: shozda@
If you have questions, please call the OTA office at 847-430-5137.
-----------------------
For ORS Office Use ONLY
Award:_________________________
For ORS Office Use ONLY
Award:_________________________
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- potomac valley alumnae chapter
- annual report to congress on the assistive technology act
- property outline santa clara law
- southwest section awwa
- the encyclopedia of ethical failure usda office of ethics
- texas crime prevention association
- cwu home central washington university
- docent program description
- adult community and further education board annual report
- requirements for the application process
Related searches
- the whole process of photosynthesis
- explain the photosynthesis process pdf
- the writing process pdf
- requirements for or requirements of
- the aging process in the elderly
- the chemical process for respiration
- application for the pell grant online
- the decide process for health
- you would be in which of the following phases of the segmentation process if you
- application for the army
- ancc application process for application for certification
- requirements for traveling outside the usa