AwardingCash prizes totaling $3,000.00 will be distributed for this competition. Hand

General Information The Scholarship and Research Committee of the ICSand all surgical specialties (including anesthesiology, pathology and radiology) to pertinent clinical application for this comp

How to EnterComplete the application portion of this form and submit it along with:

a copy of the original clinical research paper and

a 250 word

and conclusions.

Applicant All applicants will be required to present their papers at our Annual and travel accommodations are the responsibility of the submitting authors.

All presentations MUST

All submissions must be original and may not have been previously presented or entered in other competitions.

The deadline for application and paper submission is Monday,

JudgingPapers will first be judged and scored by the members of the ICSAn additional panel of judges will be assembled at the Annual Surgical Update to score the oral presentafrom both panels will be totaled and the winners announced at the conclusion of the meeting.

QuestionsContact Paul Pancer at 1.800.766.FICS, Extension 3126 or Email: ppancer@ameritech.net

INTERNATIONAL COLLEGE OF

Awarding

Cash prizes totaling $3,000.00 will be distributed for this competition. Hand

General Information –The Scholarship and Research Committee of the ICSand all surgical specialties (including anesthesiology, pathology and radiology) to pertinent clinical application for this comp

How to Enter

Complete the application portion of this form and submit it along with:

copy of the original clinical research paper and

a 250 word abstract of the same with four separate paragraphs, on

and conclusions.

Applicant Rules and Submission GuidelinesAll applicants will be required to present their papers at our Annual and travel accommodations are the responsibility of the submitting authors.

All presentations MUST

All submissions must be original and may not have been previously presented or entered in other competitions.

The deadline for application and paper submission is Monday,

Judging

and Award DistributionPapers will first be judged and scored by the members of the ICSAn additional panel of judges will be assembled at the Annual Surgical Update to score the oral presentafrom both panels will be totaled and the winners announced at the conclusion of the meeting.

Questions

Contact Paul Pancer at 1.800.766.FICS, Extension 3126 or Email: ppancer@ameritech.net

INTERNATIONAL COLLEGE OF

INTERNATIONAL

RESEARCH SCHOLARSHIP COMPETITION

Cash prizes totaling $3,000.00 will be distributed for this competition. Hand

–

Eligibility

The Scholarship and Research Committee of the ICSand all surgical specialties (including anesthesiology, pathology and radiology) to pertinent clinical application for this competition

Complete the application portion of this form and submit it along with:

copy of the original clinical research paper and

abstract of the same with four separate paragraphs, on

Mail all documents to:

Submission GuidelinesAll applicants will be required to present their papers at our Annual and travel accommodations are the responsibility of the submitting authors.

All presentations MUST be given by the submitting applicant.

All submissions must be original and may not have been previously presented or entered in other competitions.

The deadline for application and paper submission is Monday,

and Award Distribution

Papers will first be judged and scored by the members of the ICSAn additional panel of judges will be assembled at the Annual Surgical Update to score the oral presentafrom both panels will be totaled and the winners announced at the conclusion of the meeting.

Contact Paul Pancer at 1.800.766.FICS, Extension 3126 or Email: ppancer@ameritech.net

INTERNATIONAL COLLEGE OF SURGEONS

NTERNATIONAL

UNITED STATES SECTION

I CS

RESEARCH SCHOLARSHIP COMPETITION

APPLICATION

Cash prizes totaling $3,000.00 will be distributed for this competition. Hand

The Scholarship and Research Committee of the ICS-US Section invites medical students, fellows, and residents in general surgery and all surgical specialties (including anesthesiology, pathology and radiology) to

etition.

Complete the application portion of this form and submit it along with:

copy of the original clinical research paper and

abstract of the same with four separate paragraphs, on

Mail all documents to:

Submission Guidelines

All applicants will be required to present their papers at our Annual and travel accommodations are the responsibility of the submitting authors.

be given by the submitting applicant.

All submissions must be original and may not have been previously presented or entered in other competitions.

The deadline for application and paper submission is Monday,

Papers will first be judged and scored by the members of the ICSAn additional panel of judges will be assembled at the Annual Surgical Update to score the oral presentafrom both panels will be totaled and the winners announced at the conclusion of the meeting.

Contact Paul Pancer at 1.800.766.FICS, Extension 3126 or Email: ppancer@ameritech.net

SURGEONS – UNITED STATES SECTION

NTERNATIONAL COLLEGE OF

UNITED STATES SECTION

I CS -US2010

RESEARCH SCHOLARSHIP COMPETITION

APPLICATION

Cash prizes totaling $3,000.00 will be distributed for this competition. Hand-crafted certificates will also accompany the cash

US Section invites medical students, fellows, and residents in general surgery and all surgical specialties (including anesthesiology, pathology and radiology) to

Complete the application portion of this form and submit it along with:

abstract of the same with four separate paragraphs, one for each identifying purpose, methods, results,

ICS-US Dept. of CME

1516 N. Lake Shore Drive

Chicago, IL 60610

All applicants will be required to present their papers at our Annual Surgical Updateand travel accommodations are the responsibility of the submitting authors.

be given by the submitting applicant.

All submissions must be original and may not have been previously presented or entered in other competitions.

The deadline for application and paper submission is Monday, November 30

Papers will first be judged and scored by the members of the ICS-US Section Scholarship Committee prior to the Annual Meeting. An additional panel of judges will be assembled at the Annual Surgical Update to score the oral presentafrom both panels will be totaled and the winners announced at the conclusion of the meeting.

Contact Paul Pancer at 1.800.766.FICS, Extension 3126 or Email: ppancer@ameritech.net

UNITED STATES SECTION

OLLEGE OF SURGEONS

UNITED STATES SECTION

US

RESEARCH SCHOLARSHIP COMPETITION

crafted certificates will also accompany the cash

US Section invites medical students, fellows, and residents in general surgery and all surgical specialties (including anesthesiology, pathology and radiology) to submit an original

for each identifying purpose, methods, results,

US Dept. of CME

1516 N. Lake Shore Drive

Chicago, IL 60610

Surgical Update, May 5-8, 20

All submissions must be original and may not have been previously presented or entered in other competitions.

November 30, 2009. NO EXCEPTIONS.

US Section Scholarship Committee prior to the Annual Meeting. An additional panel of judges will be assembled at the Annual Surgical Update to score the oral presentafrom both panels will be totaled and the winners announced at the conclusion of the meeting.

Contact Paul Pancer at 1.800.766.FICS, Extension 3126 or Email: ppancer@ameritech.net

UNITED STATES SECTION – 2010

URGEONS

crafted certificates will also accompany the cash

US Section invites medical students, fellows, and residents in general surgery original

clinical research paper with

for each identifying purpose, methods, results,

, 2010, in Denver, Colorado. Lodging

All submissions must be original and may not have been previously presented or entered in other competitions.

, 2009. NO EXCEPTIONS.

US Section Scholarship Committee prior to the Annual Meeting. An additional panel of judges will be assembled at the Annual Surgical Update to score the oral presentation of the research. Scores

0

SCHOLARSHIP APPLICATION

crafted certificates will also accompany the cash prizes.

US Section invites medical students, fellows, and residents in general surgery clinical research paper with

for each identifying purpose, methods, results,

Denver, Colorado. Lodging

US Section Scholarship Committee prior to the Annual Meeting. tion of the research. Scores

SCHOLARSHIP APPLICATION

prizes.

SCHOLARSHIP APPLICATION

Instructions

Please complete Parts 1 and 2 of this form. Part 3 should be completed by an official representative of your hospital/school program. Return this form along with your abstract and complete manuscript to the address provided on the cover page.

PART I – Personal Information

Name: ________________________________________________________________________________________

Address: ______________________________________________________________________________________

City: ________________________________ State: __________________ Zip Code: _______________________

Phone: ______________________________ Email: ___________________________________________________

PART II – Education

I am a (check one): Medical Student Surgical Fellow Resident

Present Affiliation: ______________________________________________________________________________

I expect to complete my training on (date): ________________________________________

Previous Education: (Please provide name of institution, location, degree earned, and year.)

Pre-Med: ______________________________________________________________________________________

Medical School: ________________________________________________________________________________

Residency: _____________________________________________________________________________________

Applicant Signature and Date: _________________________________________________________________

PART III – Certification – IMPORTANT

(This section to be completed by a university or hospital program official!)

University or Hospital Name: ______________________________________________________________________

Street Address: __________________________________________________________________________________

City: __________________________________ State: __________________ Zip Code: _______________________

Phone: ________________________________ Email: ___________________________________________________

Applicants Name (As it appears on official records): __________________________________________________________________

I certify that the applicant whose signature appears on this application is enrolled as stated and is in good standing. To the best of my knowledge, the statements in this application are accurate and represent the applicant’s status.

Completed by:

Name: ________________________________________________ Title: _____________________________________

Signature: ____________________________________________ Date: _____________________________________

ICS-US, Dept. of CME, 1516 N. Lake Shore Drive, Chicago, IL 60610 – Phone: 312.787.6274, Extension 3126