test

Name:

First

Last

E-mail:

Select preferred presentation style:*

Podium Presentation

Poster Presentation

Either Podium or Poster Presentation

Other type of presentation: workshop, roundtable, panel, debate, ask an expert, etc.

Describe:

Select a category that best fits your abstract. You may check more than one category:*

Education

Evidence-Based Clinical Practice

Health Policy / Affordable Care Act

Hot Topics in Critical Access Hospitals

Clinical and Systems Interventions

Research

Clinical Outcomes / Health Disparities

Quality and Clinical Markers in Rural Hospital

Name of Submitting Author, Credentials, Affiliation:*

Please list Co-Authors, Credentials, Affiliation:

Source of Funding for Project:*

Applicable

Not Applicable

If Applicable, provide source of funding for project:

Abstract Title:*

ABSTRACT - include Purpose / Aim, Background, Methods, Results, Implications for rural health and/or rural nursing practice (lilmited to 500 words):*

Has this been previously presented / published? Please identify:*

Word Verification:

2016 International Rural Nursing Conference

ABSTRACT REVIEW TEAM APPLICATION

First Name:*

Last Name:*

Email:*

Please submit a short statement of your qualifications as a reviewer (300 words or less). Include a short synopsis of your current role.*

Previous experience as a reviewer?

Yes

If yes, please explain:

Please select categories below that you feel qualified to review: