Ohio State Neurosurgical Society

 

 

 

ANNUAL MEETING

Saturday, April 28, 2012

Kingsgate Marriott
Convention Center
151 Goodman Drive
Cincinnati, OH 45220

 

 

 

QUESTIONS?

If you have any questions
about the meeting or your
presentation, please contact:

Dale S. Horne, MD, PhD, FACS
dhorne@ohsns.org
Phone (513) 936-1390
Fax (513) 791-5306

RESIDENT PRESENTATION APPLICATION


PLEASE COMPLETE AND RETURN FORM BELOW BY
SATURDAY, APRIL 21, 2012 TO BE ELIGIBLE FOR AN AWARD

First Name A value is required.
   
Last Name A value is required.
   
Please select an item.
   
Street Address A value is required.
   
City A value is required.
   
State Please select an item.
   
Zip A value is required.Invalid format.
   
Work Phone Invalid format.
   
Mobile Phone Invalid format.A value is required.
   
Email Address Invalid format.A value is required.
   
Research Advisor A value is required.
   
Title of Presentation A value is required.
   
   

 

 

 

 

PRESENTATION AWARD CATEGORIES:

FIRST PLACE: $500

SECOND PLACE: $300

THIRD PLACE: $100