The 54th Annual Scientific Meeting of the Japanese Society for Nuclear Medicine
Japan-China Nuclear Medicine Exchange Seminar
ABSTRACT SUBMISSION FORM
-------------------------------------------------------------------------------Participant to Japan-China Nuclear Medicine Exchange Seminar
(Required)
Yes
No
If your abstracts are not selected for Japan-China Nuclear Medicine Exchange Seminar, are you
willing to have presentations at the appropriate JSNM oral presentation session ?
(Required)
Yes
No
First Author (Required)
First Name_Middle Initial : (ex.) John E.
Last/Surname : (ex.) Smith
All postal communications will be forwarded to the presenting author c/o the address of the
institution input below.
Institution 1 (Required) :
(ex.) Department of Hematology, Baltimore Memorial Hospital, USA
Country (Required):
Address (Required) :
(ex.)715 Pale St., Baltimore, Maryland
Postal/Zip Code (Required) :
(ex.)20124
Telephone Number (Required) +country code - area code – number :
(ex.)+1-410-765-4321
Fax Number :
(ex.)+1-410-765-4321
E-mail Address (Required):
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Coauthor(s)
In case the coauthors' institution(s) is different from the presenting author's, enter the name(s) of the
institution(s) below.
Then input coauthors' name(s) and select the number(s) to indicate the institution(s) from the list below.
Institution 2
Institution 3
-------------------------------------------------------------------------------Co Author 2
First Name_Middle Initial:
Last/Surname:
Institution Number: (1 / 2 / 3)
-------------------------------------------------------------------------------Co Author 3
First Name_Middle Initial:
Last/Surname:
Institution Number:
-------------------------------------------------------------------------------Co Author 4
First Name_Middle Initial:
Last/Surname:
Institution Number:
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Co Author 5
First Name_Middle Initial:
Last/Surname:
Institution Number:
-------------------------------------------------------------------------------Co Author 6
First Name_Middle Initial:
Last/Surname:
Institution Number:
-------------------------------------------------------------------------------Co Author 7
First Name_Middle Initial:
Last/Surname:
Institution Number:
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Title of Abstract (Required)
-------------------------------------------------------------------------------Abstract Body (Required)
Please make your abstract (author, institution, title, body) concise to be less than 900 characters
including space.