2020 Star of the North Meeting – Student Table Clinic Application

Applications are due by 4:00 pm on Friday, December 20, 2019

Notes:

Late applications will not be accepted. To submit, complete the form below.
All student clinicians must register for the Star of the North Meeting and pay any applicable registration fees. Please note that Star of the North Meeting registration will open on January 2, 2020.

To maximize the number of people that can participate in the Table Clinics and to make the best use of your time, only one table clinic session is being offered in 2020 for student clinicians. Please schedule your participation in educational programming accordingly.

The session will be taking place on Saturday, April 25, 2020 from 10:00 am – 12:00 pm.

Student Table Clinic Application

Primary Clinician (all correspondence will be directed to this person)*
First Last
Primary Clinician Registration Category*
Title*
Name*
First Last
Email*
Address (This is where your badge and materials will be mailed.)*
Street Address Address Line 2 City State ZIP Code
Name of School, Hospital or Company*
Division (if applicable)
Title of Presentation*
General Topic*
Summary of Presentation (Applications will not be accepted without a summary)*
I will have a Co-Presenter*
Co-Presenter 1 Registration Category*
Co-Presenter 1 Title*
Name of Co-Presenter 1*
First Last
I will have a 2nd Co-Presenter*
Co-Presenter 2 Registration Category*
Co-Presenter 2 Title*
Name of Co-Presenter 2*
First Last
As the Primary Student Clinician, I have read the 2020 Table Clinic Rules and agree to abide by the regulations contained therein.*