Contact Dermatitis 2006 – Blending Science with Best Practice

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Presentation Submission Form

Submission of your contact information below will send an E-mail to the organizing committee, who will compile a mailing list to distribute further information. It is not our intention to release this information for any other purpose.

*Name
*E-mail address
Affiliation
Mailing Address
Telephone
Fax
	*Required information
Which meeting are you interested in attending (see Meeting Registration menu)?
Both ECDRG and ACDS meetings
Only ECDRG meeting
Only ACDS meeting
Will you be submitting a title for presentation at the ECDRG sessions? If so, list the title here:
Will you be submitting an abstract for presentation at the ACDS sessions? If so, please submit the title and abstract here (250 words or less):
If a research fellow or resident, do you want your presentation to be judged for the Young Investigator's Award?
Yes
No