ISSCR Invited Abstract & Speaker Registration

POSTER ABSTRACT
SUBMISSION FORM
TRAUMATIC STRESS RESEARCH:
ENABLING BEDSIDE IMPLEMENTATION
A Joint ISTSS/CIMVHR Conference
May 9-10, 2016
Allstream Centre, Toronto Ontario

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Presenter Name, Institution and Contact Information

Name
Degree
Institution
Institution Address
Phone
Email

Additional Authors,Institutionsand Contact Information

Name
Degree
Institution
Institution Address
Phone
Email
Name
Degree
Institution
Institution Address
Phone
Email
Name
Degree
Institution
Institution Address
Phone
Email

Abstract Title

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Abstract

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In what country/region is this work focused? / Program Type? / Population Type?
☐Canada / ☐Assessment/Diagnosis / ☐Military/Veterans
☐USA / ☐Biological/Medical / ☐Child/Adolescent
☐Other Industrialized Countries
Country:______/ ☐Clinical/Intervention Research / ☐Adult
☐Central and Eastern Europe & the Common Wealth of Independent States / ☐Clinical Practice / ☐Older People/Aging
☐Eastern and Southern Africa / ☐Community-Based Programs / ☐Both Adult and Child/Adolescent
☐East Asia and the Pacific / ☐Culture/Diversity / ☐Mental Health Professionals
☐Global / ☐Ethics / ☐Other Professionals
☐Latin America & the Caribbean / ☐Global Issues
☐Middle East & North Africa / ☐Journalism and Trauma
☐South Asia / ☐Multi-Media
☐West & Central Africa / ☐Prevention/Early Intervention
☐Research Methodology
☐Social Issues – Public Policy
☐Technology
☐Training/Education/Dissemination
☐Vicarious Traumatization and Therapist Self-Care

Is there any material that may be distressing to your audience? ☐Yes☐No

If yes, describe

Ethics and Presentation Policies: Submission of your presentation indicates you have read and agree to these policies and statements.

Ethics
Statement of Ethical Standard: All work presented at the meeting must conform to applicable governmental regulations and discipline-appropriate professional ethical standards. Responsibility for meeting these requirements rests with those who submit proposals and those who make presentations at the meeting.
Human and animal research studies generally require approval by an institutional research committee that has been established to protect the welfare of human or animal subjects. Presentation of findings from approved research studies is consistent with the ethical standard for the meeting.
Data collection as part of clinical services or for program evaluation purposes generally does not require approval by an institutional research committee. However, analysis and presentation of such data outside the program setting may qualify as research (i.e., an effort to produce generalizable knowledge) and require approval by an institutional committee. Those who submit abstracts to thismeeting based on data from these sources are encouraged to consult with a representative of the applicable institutional committee to determine if approval is needed.
Presentations that report on a particular person (e.g., a clinical case) generally require written permission from that person to allow public disclosure for educational purposes, and typically involve alteration or withholding of information that might directly or indirectly reveal identity and breach confidentiality.
By presenting at this meeting, I acknowledge that I have read the information about the ethical standard for presentations and accept responsibility for ensuring that the material I am submitting for possible presentation conforms to this standard.
Initial here: ______
Presentation Agreement
PRESENTATION AGREEMENT REMUNERATION
I understand that I will receive no remuneration from ISTSS or CIMVHR for my participation unless explicitly stated.
ASSURANCE OF CLIENT CONFIDENTIALITY
I understand that I am responsible for ensuring that any information presented regarding clients of mental health services be sufficiently edited or modified to ensure the confidentiality of the clients unless I have obtained specific permission according to applicable ethical standards, laws and regulations from any client about whom identifying information is presented.
PERMISSION FOR USE OF NAME AND LIKENESS
I hereby give the ISTSS and CIMVHR, their agents and representatives the right to use my name and likeness in promotional and other material published in relation to the meeting.
PERMISSION FOR PUBLICATION OF MATERIAL
To the extent that this work is not in the public domain (e.g., by virtue of being performed by an employee of the U.S. Federal Government as part of their official duties), I agree to grant the ISTSS and CIMVHR copyright permissions for publication of material I may provide for inclusion in the proceedings for the conference which may be published in print and online on their respective Web sites. The copyright consists of any and all rights allowed by the copyright laws of the United States and all foreign countries. I understand that the proceedings, including my contribution, will be made available in printed form to the attendees of the conferenceand other interested parties. I understand that ISTSS and CIMVHR will hold the copyright for the proceedings and its contents. I understand that the copyright of the compilation of materials in the proceedings is not the same as the copyright of an individual item of material included in the proceedings. I understand that I am encouraged to include copyright notices as appropriate on all the materials I submit. I understand that ISTSS and CIMVHR take no responsibility for registering my copyright and advises me to take all appropriate steps to do so.
I authorize ISTSS and CIMVHR to sell or otherwise distribute said proceedings to their memberships and general public. In return, I understand that ISTSS and CIMVHR grant me the right to reprint my contribution in any publication.
I affirm that my contribution contains no matter that is defamatory or is otherwise unlawful or invades individual privacy, or infringes on any proprietary right or statutory copyright. I affirm that my contribution is original with me or that I have obtained permission at my own expense from the copyright holder for publication and will submit documentation, showing permission for use, to ISTSS and CIMVHR at the time of submission of the materials to be distributed.
INDEMNIFICATION AGREEMENT
I agree to indemnify and hold harmless the, ISTSS, CIMVHR, their agents and representatives should the material I present or provide for publication be determined to defame, libel or slander an individual or organization, violate the confidentiality of any individual or organization, or infringe on another's copyright.
Initial here: ______

Return completed form to the International Society for Traumatic Stress Studies

Attention Michael Hagedorn,

DEADLINE February 2, 2016

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