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Frank Buczek Phd
07-10-1998, 04:14 AM
1999 GCMA Annual Meeting -- Program Submission Form A

Abstract/Poster Title:

__________________________________________________ __________


__________________________________________________ __________

Presenting Author Information:

Name & Degree(s):

__________________________________________________ __________

Institution:

__________________________________________________ __________

Mailing Address:

__________________________________________________ __________


Phone # __________________________


Fax # ___________________________


e-mail (clearly indicate upper/lower case, and alpha/numeric characters)

__________________________________________________ __________

Co-author Information: (name, degrees, institution or affiliation)

__________________________________________________ __________

__________________________________________________ __________

__________________________________________________ __________

__________________________________________________ __________


Preferred Presentation Style: (check one)

___ Podium ___ Poster

If a podium slot is not available, will you present a poster?

___ Yes ___ No


Student Status: Complete the next three items only if you
wish to be considered for a student award.

Current Course Load (credit hours) ________________________

Advisor Signature: ______________________________________

Check here if less than two years post-graduation,
and submitted abstract reflects your student work: ____________

Topic Area: (please mark "1" for primary area, "2" for secondary area)

___ Biomechanical Modeling ___ Posture/Balance

___ Orthotics/Prosthetics ___ Motor Control

___ Functional Assessment ___ Energy Consumption

___ Kinematics & Kinetics ___ Clinical Decision Making

___ Electromyography ___ Quality Assurance/Reliability

___ Other: _____________________


Please return to the address below,
to be RECEIVED by September 11, 1998:

Frank L. Buczek, Jr., Ph.D.
Program Chair, 1999 GCMA Annual Meeting
Shriners Hospitals for Children
1645 West 8th Street, Erie PA 16505
(814) 875-8700 (needed for overnight delivery)

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