To submit your abstract, please complete the below form. If you experience a problem with the online submission form and/or do not receive a submission confirmation message, please email info@painweek.org for further instructions.

The deadline for electronic submissions is June 28, 2010. All authors will be notified via e-mail beginning July 12. Accepted abstracts will be listed online by August 30, 2010.

Note: You must click "Done" at bottom of this form to successfully submit your information.

	Your First Name*

	Your Middle Initial

	Your Last Name*

	Your Phone Number*

	Your Fax Number

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Abstract Type*

Clinical Study

Case Study

Other

	Title (use initial caps as appropriate)*

	Author

	First Name*

	Middle Initial

	Last Name*

	Degree(s)*

	Institution*

	Additional Author (if applicable)

	First Name

	Middle Initial

	Last Name

	Degree(s)

	Institution

	Additional Author (if applicable)

	First Name

	Middle Initial

	Last Name

	Degree(s)

	Institution

	Additional Author (if applicable)

	First Name

	Middle Initial

	Last Name

	Degree(s)

	Institution

	Additional Author (if applicable)

	First Name

	Middle Initial

	Last Name

	Degree(s)

	Institution

	Additional Author (if applicable)

	First Name

	Middle Initial

	Last Name

	Degree(s)

	Institution

	Additional Author (if applicable)

	First Name

	Middle Initial

	Last Name

	Degree(s)

	Institution

	Additional Author (if applicable)

	First Name

	Middle Initial

	Last Name

	Degree(s)

	Institution

	Purpose (limit 100 words)*

	Methods (limit 150 words)*

	Results (limit 300 words)*

	Conclusion (limit 100 words)*

	Funding provided by:

	Disclosures (limit 50 words)* (Financial and/or In-kind support)

	Principal Presenter

	First Name*

	Middle Initial

	Last Name*

	Degree(s)*

	Phone Number*

	Fax Number*

	E-mail Address*

	Co-Presenter

	First Name

	Middle Initial

	Last Name

	Degree(s)

	Phone Number

	Fax Number

	E-mail Address

	Organization Submitting Abstract (if applicable)

	Organization Name

	Contact Name

	Contact Phone Number

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	Contact E-mail Address

Please check this box if you do not wish to have your abstract published in a post-conference proceedings.