USCPC Registration Form - American Association for Cancer

SATURDAY, APRIL 18, 2015 • 10:00 a.m.-4:00 p.m.
PENNSYLVANIA CONVENTION CENTER
PHILADELPHIA, PA
TENTH ANNUAL
UNDERGRADUATE STUDENT
CAUCUS AND POSTER
COMPETITION
The Tenth Annual Undergraduate Student Caucus and Poster
Competition (USCPC) brings together undergraduate and post
baccalaureate students to address educational pathways, explore
career options in the cancer field, and compete for prizes while
presenting their research.
The program is FREE, and lunch is provided. In addition,
complimentary registration for the entire AACR Annual Meeting
2015 (April 18-22) will be extended to all student participants.
Poster presenters must also submit their abstract at
http://myAACR.aacr.org. If you do not have a myAACR account,
you will need to create an account.
Deadlines
Abstract Deadline: Registration Deadline: Friday, March 6
Friday, March 20
Eligibility
Questions?
Full-time undergraduate and post baccalaureate students are
invited to participate and/or to submit an abstract for poster
presentation during this special session.
Web: www.aacr.org/uscpc15
Email: [email protected]
Phone: 215-440-9300
Toll-free: 866-423-3965
Prizes for Poster Competition
Attendees at this session may also choose to enter the poster
competition. Poster competition winners will be awarded the
AACR-Gary J. Miller Prizes for Cancer and Cancer-Related
Biomedical Research. First prize consists of $1,500 for participation
in the AACR Annual Meeting 2016 in New Orleans, La. Second
($300) and third place ($200) prizes will also be awarded, as
well as Meritorious Honors for the top ten posters, and a People’s
Choice Award. Prizes are judged by AACR member scientists.
This is a special poster session for students, and there is a separate
abstract submission process (abstracts submitted to the general
AACR Annual Meeting 2015 poster sessions were due December 3,
2014). Students are welcome to present abstracts that will also be
presented elsewhere at the meeting.
Registration
All eligible students wishing to attend the session and/or compete
in this poster competition must complete and submit an Advance
Registration Form. See reverse side for advance registration form.
Mentoring Opportunities
Are you an AACR Member interested in serving as an
abstract reviewer and judge for the USCPC? Email us at
[email protected] to volunteer.
AACR
This program takes place at the American Association for
Cancer Research’s Annual Meeting 2015, April 18-22, 2015 in
Philadelphia, Pennsylvania.
Founded in 1907, AACR is the world’s oldest and largest
professional organization dedicated to advancing cancer research
and its mission to prevent and cure cancer. AACR membership
includes more than 35,000 laboratory, translational, and clinical
researchers; population scientists; other health care professionals;
cancer advocates; and students residing in 97 countries.
Thank you for your support of the AACR and its activities. We look
forward to seeing you in Philadelphia!
TENTH ANNUAL UNDERGRADUATE STUDENT
caucus and poster competition
REGISTRATION FORM
Abstract Submission Deadline
March 6, 2015
Advance Registration Deadline
March 20, 2015
SATURDAY, APRIL 18, 2015 • 10:00 a.m.-4:00 p.m.
PENNSYLVANIA CONVENTION CENTER • PHILADELPHIA, PA
Section 1. Student Information
Section 3. Demographic Information (optional)
Are you an AACR Member? q Yes q No Membership #: _____________
Information concerning gender and ethnic background is requested only to
enable the AACR to ensure that its programs are serving all members of its
diverse cancer research community.
q Mr.
q Ms.
Last/Family Name, First Name, Middle Initial
Race or Ethnic Background: (check only one)
q Caucasian q Native American
q African American or Black
q Alaskan Native
q Hispanic or Latino q Native Hawaiian/Pacific Islander
q Asian q Other
Institution
Name of Institution
Gender: (check only one) q Male q Female
Mailing Address
Section 4. Poster Competition
City, State, or Province
Zip/Postal Code
Country (if not U.S.)
Contact Information
Students who wish to present a poster must submit their abstract online
at http://myAACR.aacr.org before March 6, 2015. (Log on to myAACR. If
you do not have a myAACR account, you will need to create an account.
Once logged on, navigate to the Abstract tab to begin an online abstract
submission for the Tenth Annual Undergraduate Student Caucus and
Poster Competition).
Do you intend to present a poster at the Tenth Annual Undergraduate
Student Caucus and Poster Competition?
q Yes q No
Mailing Address
City, State, or Province Zip/Postal Code
Section 5. Institutional Certification
This section must be completed by a mentor, advisor, professor, or
departmental chair from the institution at which the registering student
is matriculated.
Country (if not U.S.)
Phone Number
Last/Family Name, First Name, Middle Initial
Email Address
Section 2. Education
Institution
Year of Study:
q Freshman
q Sophomore
q Post-Baccalaureate
Department
q Junior
q Senior
q Other: ___________________________
Primary Field of Research (please check only one):
q Behavioral Science
q Immunology
q Biochemistry and Biophysics
q Molecular Biology
q Biostatistics/Bioinformatics
q Preclinical Pharmacology
q Carcinogenesis
and Experimental/
q Cellular Biology
Molecular Therapeutics
q Chemistry
q Prevention Research
qC
linical Research/
q Radiation Oncology/
Clinical Trials
Radiation Biology
q Computational Biology
q Research Administration/
q Endocrinology
Business Development
q Epidemiology
q Tumor Biology
q Genetics and Genomics
q Virology
q Other (please specify): _______________________________________
Fax: (215) 440-9412
Email: [email protected]
Abstract submission: http://myAACR.aacr.org
Phone Number
Email Address
I hereby certify that this registrant is a full-time student at the institution
listed above.
Mentor/Advisor Signature Date
Student Signature Date
FOR AACR USE ONLY
REG. CODE:
USCPC MEMBER COMPLIMENTARY