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AEEDC Dubai World Orthodontic 2016 Conference 31st January – 1st February Dubai International Convention and Exhibition Centre Conference Lecture Abstract Form Deadline: 1st August 2015 For office use only Please complete and submit this form to: INDEX Conferences & Exhibitions Organisation Est. P.O. Box: 13636, Dubai – United Arab Emirates Tel: +971 4 3624717, Fax: +971 4 3624718 E-mail: [email protected] Date Rcvd. ______________________ Reg. No. ________________________ Abs. No. ________________________ Speaker’s Name: Title: Prof. Dr. ________________________ Accelerated Orthodontics Cleft Lip and Palate: The Orthodontic Aspect Functional Appliances Imaging : Old and New Orthodontic Aligners Surgically Assisted Orthodontics Temporary Anchorage Other ,please specify---------------------------------------------- Presentation Field: Sector: Other, please specify UAE GCC & MENA region International Academic Private Other, please specify ________________________ Degree: ( e.g. :MSc. FDS RCS, PhD, FHEA ) Current Position: Short Biography: (Maximum 40 words) CV: Kindly attached your full CV Photograph: (passport size) Kindly attached your recent photograph:(High resolution) Format: JPG or pdf Resolution:300dpi File size: more than 1mb Presentation Title: (Maximum 20 words) Abstract: (Maximum of 100 words) Introduction: (Maximum of 200 words) Learning Objectives: (5 Objectives required. These should also be in your presentation) Presentation Slides: Presentation Slides” outline is mandatory for the accrediting of any lecture. Kindly find the below guidelines for your perusal: You may send the outline in the following formats: word document, pdf form scanned copies. The lecture content should not be of commercial nature ( no endorsement for any specific commercial drugs, materials, products, treatments, or services) Acknowledge the speaker sources by citing the references in presentation slides. The DHA accreditation Committee may request further information or documentation on a case by case basis and both AEEDC and the speaker are obliged to comply. Literature Review : Provide at least three literature references in relation to your presentation. Who should attend your lecture? General Practitioners Expected duration: Note: Have you previously presented any lecture /course in any regional /International events? Specialists 30 minutes 45 minutes 60 minutes For Joint Lectures: 90 minutes 120 minutes Yes or No If yes, please specify the name of the event. Note: Please provide information if this lecture has been presented previously or will be before AEEDC Dubai World Orthodontic 2016 Conference? If yes, please specify: Your Contact Information Organisation: Tel: Mob: Fax: Email: Address: Abstracts not complying with the specified format will not be considered. Abstract Submission Guidelines: *(The term organizer means INDEX Conferences & Exhibitions Organisation Est.) Abstract should not exceed 100 words. The abstract must be in English, font size 12 in Times New Roman fonts and with single-line spacing. Abstracts should be submitted by e-mail or through online submission at www.aeedc.com. Abstracts that are handwritten, or sent by fax will not be accepted. Abstract content must meet the standard of an academic / scientific presentation. In cases of research or clinical study, the abstract must be based on the original research or original clinical case studies, or their modifications. The AEEDC Scientific Committee will evaluate the content of each abstract and make the final selection of the abstracts for presentation. The presentation must cover the same material as the abstract. If the abstract has been selected for presentation the speaker automatically gives permission for the abstract published in the conference program or to any postconference announcement. Optional: Would you agree to upload your presentation or a recording of your lecture on the event’s website? Yes No No abstracts will be considered after 1st August 2015. For any withdrawals, the speaker should notify the *organiser in writing as soon as possible or minimum of 2 months prior to the event. Any particular equipment and materials which is necessarily to conduct the session is be declared to organizer and approved to be obtained latest by the submission of the presentation. P.S: Please respect the deadline for presentation submission (1st of October 2015) delay in submission the presentation will result in delay on CPD accreditation and possibly in cancellation the session. For AV preparation, the below will be provided during conference presentation: Projection Screen size: 3.2 m height x 4.3 m width(10.5ft x 14ft) LCD Projector – 10000 ANSI LUMENS Laptop DVD player (in case of movies) Audio System and Speakers Podium Microphones Headset Microphone or Lapel Microphone Laser pointer. Clicker remote P.S: Special requirement and specifications need to be requested and reconfirmed with the organizer. Disclaimer Statement In order to maintain efficiency, the following disclaimer should be signed and understood, informing both the Speaker/Author and *Organizer/Event responsibilities. 1. I understand that the submission of an abstract does not automatically entitle me to participate in AEEDC Dubai World Orthodontic 2016 Conference neither as a speaker nor as a participant. 2. Being a speaker/author in AEEDC Dubai World Orthodontic 2016 Conference, I undertake to complete and submit any other disclosure statements required by any other organisation, including the conference organizer, in relation to my participation in AEEDC Dubai World Orthodontic 2016 Conference, and I guarantee that the disclosure statement will be complete and truthful to the best of my knowledge. 3. I understand that being a speaker /author in AEEDC Dubai World Orthodontic 2016 Conference, my name will be automatically included in the nomination list of speakers for the Best Speaker Award. 4. I have made every effort to guarantee the accuracy of the information supplied within the Abstract Form, and disclaim all warranties with regards to the information included on the Abstract Form without limitation. 5. I fully understand that AEEDC Dubai will not be held responsible for any errors or omissions in the information provided in this form. 6. I understand that I will be solely responsible for my presentation, equipment such as hard disk, flash memories, CDs, DVD, laser pointers, portable computer devices, etc. and that AEEDC Dubai takes no responsibility, and disclaims any liability, for any personal equipment in regard to my presentation. 7. I guarantee to not conduct any CME events (Conference, Courses, Seminars, Symposiums, Demonstrations, Workshops, etc.) 30 days before, or 30 days after the AEEDC Dubai World Orthodontic 2016 Conference in United Arab Emirates unless agreed with INDEX. 8. I guarantee to not conduct any CME events (Conference, Courses, Seminars, Symposiums, Demonstrations, Workshops, etc.) on similar or the same topic/subject/title 3 months before, or 3 months after the AEEDC Dubai World Orthodontic 2016 Conference in United Arab Emirates unless agreed with INDEX. 9. I understand that I need to have travel insurance and the *organizers are not liable for any emergency related to travelling to the event. 10. I understand that in case accepted to lecture at AEEDC Dubai World Orthodontic 2016 Conference, the *organizers cannot guarantee specific time or date and program slot for my speech, and that last minute program changes are possible due to unforeseen circumstances and are accepted by me. 11. I understand that if accepted to present at AEEDC Dubai World Orthodontic 2016 Conference, I have to provide my presentation (soft version) at least one month before the announced date of the presentation. 12. I understand that photos will be taken during my presentation for marketing purposes. 13. I understand that it is my responsibility to inform my presentation attendees of any hazards risks involved in the clinical application of the information presented without sufficient education, training and/or supervision. 14. I, the undersigned, declare that neither I, nor any member of my family has any financial arrangement or affiliation with any corporate organisation offering financial support for this continuing dental education programme, nor do I have a financial interest in any commercial product(s) or service(s) discussed in the presentation. a. If yes, please state the name of the organisation and the kind of affiliation: 15. I understand that any handout materials to be distributed during or at the conference/course presentation must be submitted to the AEEDC Scientific Committee at least one month prior to the event for approval. Only approved handout materials can be distributed during the conference/course session. 16. “Presentation Slides” outline is mandatory for the accrediting of any lecture. Kindly find the below guidelines for your perusal: You may send the outline in the following formats: word document, pdf form scanned copies. The lecture content should not be of commercial nature ( no endorsement for any specific commercial drugs, materials, products, treatments, or services) Acknowledge the speaker sources by citing the references in presentation slides. The DHA accreditation Committee may request further information or documentation on a case by case basis and both AEEDC and the speaker are obliged to comply. 17. I understand that incomplete form will not be accepted as all required information should be received before the submission deadline. By signing this statement, I declare that the mentioned terms and conditions in points from 1 to 17 in the disclaimer statement and the guidelines for abstract submission and presentation are understood and accepted, and will be complied with and maintained. Signature: Date: