Star of the North Table Clinics

Applications are due by 4:00 pm on Friday, January 6, 2023

Notes:

Please review the 2023 Table Clinic Information & Rules HERE
Late applications will not be accepted. To submit, complete the form below.
All 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 4, 2023.

The session will be taking place on Friday, April 28, 2023, from 11:30 a.m. – 1:30 p.m.

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