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Abstract Submission Form


Student Name:

BGSU ID#:

Local Address:
Line 1

Local Address:
Line 2 (optional)

Local City, State, Zip Code:

E-mail Address:

Telephone Number:

Major/Minor:

Class Standing:

Was the research/creative activity on which this presentation is based supported through CURS?

Yes No

May we use your name and image for promoting this event?

If you answered YES, please provide the following information:

Yes No

 

Home - City/State/Country:
Parents' Names:
Hometown Newspaper:
Name of your high school and year you graduated:

 

Faculty Mentor Name:

Faculty Mentor Department:

Faculty Mentor E-mail Address:

Faculty Mentor
Telephone Number:

Title of Presentation:

Authors:

Has the work described in this abstract been submitted / presented previously?

Yes No

If yes, please state where and when the work was submitted/presented previously:

Abstract Text:

Please type (or copy and paste) the text of your abstract in the box below [maximum of 250 words]. The text will be copied directly from this form so please proof read it carefully. Be certain your faculty mentor has read your abstract and approves of its content before submission.

Submit or Reset Form:

 
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