1982 Abstract Submission Form

1982 American Academy of Ophthalmology ABSTRACT SUBMISSION FORM for papers, posters, scientific exhibits, and films (Please be certain you read the instructions before completing the form)

Is this abstract submitted by invitation as part of a planned symposium? __ yes

__ no

If so, which symposium? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

2. Author: Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Degree _ _ __ Academy Member: _ _ yes

Mailing Address: _ _ _ _ _ _ _ _ _ __

_ _ no

Phone: Offige Home 3. Co-Authors (attach additional sheet if necessary): Name and Degree Academy Member

1. _ _ _ _ _ _ _ _ _ _ _ __ _ _ yes

2. _ _ _ _ _ _ _ _ _ _ _ __

_ _ yes

_ _ no

Address

4. Abstract (100 words or less; must be typewritten):

209

_ _ no

210

OPHTHALMOLOGY. SEPTEMBER 1981 • PROGRAM SUPPLEMENT

5. Type of Presentation: _ _ paper

_ _ poster

__ paper or poster

_ _ scientific exhibit

_ _ film Space Requested (exhibits only): _ _ 6 ft.

__ 8 ft.

_ _ 10 ft.

_ _ 12 ft.

__ Other

6. Subject Classification (indicate the appropriate letter corresponding to the subject categories listed categories listed in the instructions): ____ 1st choice

2nd choice

7. Audiovisual Requirements (papers only; check appropriate boxes): 2" x 2" 35 mm slides: _ _ one image

16 mm motion picture: __ silent

__ two images

__ optical sound

8. Suggested Discussants (list at least two): Name and Degree Academy Member

1. _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ yes

2. _ _ _ _ _ _ _ _ _ _ _ __

__ no

_ _ yes

_ _ no

Address

Phone 9. I have complied with the instructions regarding proprietary interest. Signature of Author: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

10. Checklist: Be certain you have _ _ kept a copy of this abstract submission form _ _ enclosed a self-addressed, stamped postcard _ _ included office and home phone numbers of first author _ _ read the instructions once again to be sure your submission is complete _ _ mailed your abstract submission to the proper address