| Abstract Number(s) of Submitted Abstract(s) (*) |
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| Confirmation that as of December 1, 2019 you are a TTS Member or have applied for membership (*) |
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| Other Society Memberships OR Memberships applied for |
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| Salutation (e.g. Dr. Prof.) |
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| First Name (*) |
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| Last Name (*) |
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| Credentials (e.g. PhD, MSc) |
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| Position or Job Title |
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| Department |
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| Institution or Company (*) |
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| Address |
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| City (*) |
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| State or Province (Canada/USA ONLY) |
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| Country (*) |
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| Postal/ZIP Code (*) |
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| Telephone (*) |
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| Fax |
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| Email (*) |
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| Abstract Submitted (.doc or .pdf - Maximum 1 MB) (*) |
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| Letter from Department Chair confirming the training status of the Mentee (maximum 1 MB) (*) |
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