Pan-African Internal Medicine Review Call for Papers Form

Please make sure you have visited the Guidelines page before filling up the form below.

Email Address *

Title*

First Name*

Last Name *

Company Name *

Job Title

Department

Company Address1*

Company Address2

PO Box/Post Code/Zip Code *

City *

Country *

Mobile
(Please begin with a ‘+’ symbol and include country and city code)

Phone Number *
(Please begin with a ‘+’ symbol and include country and city code)

Fax Number
(Please begin with a ‘+’ symbol and include country and city code)

Website

Submission for * (please specify which conference session you are interested in presenting at) Osteoporosis
Common Paediatric Skin Conditions and Treatments
Asthma
Upper Respiratory Tract Infections
HIV: Latest Advances
Cardiovascular Disease
Managing Obesity
Optimal Management of a Patient on Insulin
Other, Please specify

Title of your presentation
Maximum 100 words

Three (3) behavioural objectives (i.e., what will attendee be able to do after completing your session.)

Objective 1

Objective 2

Objective 3

Topic Overview
Maximum 250 words (one paragraph to be inserted in Conference Brochure, giving an overview of your topic.)

Your Biography
Maximum 250 words (Biographies should be brief and concise. It will be used by the Session Chair to introduce you.)

Your Picture – jpg format(maximum size of 1MB)

Uploaded Files:

Errors:

**Include the outline and abstract of the presentation, your bio & electronic picture with your application. Copy this application form if you are submitting more than one topic.

Each topic should be on a separate submission form.

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