Academy of Clinical Laboratory Physicians and Scientists

ACADEMY OF CLINICAL LABORATORY PHYSICIANS AND SCIENTISTS

2010 Abstract Form

ACLPS 2010 Abstract Form Page 1 of 2

Name of Speaker (include degrees) and Mailing Address - maximum of 5 lines (total): / ( ) Check here if you do NOT want abstract published in Am. J. Clinical Pathology
Telephone:
Fax:
E-mail: / Abstracts must be received by Friday, February 19, 2010
Send electronic version to:
Fax or mail signed abstract form to:
Alexander J. McAdam, MD, PhD
Children’s Hospital Boston
300 Longwood Ave.
Boston, MA 02115
Fax (617) 730-0383

Speaker is ACLPS: ( ) Member ( ) Associate Member ( ) Non-Member

Speaker is a trainee, and so is eligible for a Paul E. Strandjord Young Investigator Award: ( )Yes ( ) No

Training Status of Young Investigator: ( ) Resident ( ) Fellow

Doctoral candidate: ( ) MD ( ) PhD ( ) MD-PhD ( ) Other student (explain):

Member Signature Required as Sponsor

Typed or printed name
Sponsor’s e-mail

Name of applicant: ______

There are two ways to apply for Associate Membership of ACLPS with this abstract submission. You may select either one of these options (don’t select both), or you may make no selection if you do not want to become an Associate Member. If you choose not to apply for membership, this will in no way affect your consideration for a Young Investigator Award. Associate Members are not required to pay dues to ACLPS.

( ) I wish to become an Associate Member of ACLPS if I receive a Young Investigator Award. I am including an electronic copy of my CV with this abstract submission.

( ) I wish to become an Associate Member of ACLPS regardless of whether I receive a Young Investigator Award. I am including; 1. an electronic copy of my CV with this abstract and 2. sponsorship forms completed by two ACLPS members. (Sponsorship forms are available under the “Memberships” tab of the ACLPS website at http://depts.washington.edu/lmaclps/.)

ACLPS 2010 Abstract Form Page 1 of 2