ADS Australasian Diabetes Congress Awards Application Form.

First Name:

Surname:

Email:

Supervisors Name:

Institution:

Department Name:

Abstract Title:

Abstract Number:

Abstract Status: My abstract is : Accepted Not Accepted Unsure

I am a junior investigator/early career researcher Yes No

My abstract is an Oral Presentation or Poster Presentation

My abstract is for Basic Science or Clinical Research

Are you applying for the ADS President’s Young Investigator Award Yes No

Are you applying for the ADS-Pincus Taft Young Investigator Award Yes No

Are you applying for an ADS Poster Award Yes No

Are you currently not more than 2 years beyond the award of a doctoral degree (PhD, MD)
or Fellowship (FRACP) Yes No

Are you a current financial ADS Member (Paid subs to 2019) Yes No

Are you applying for the Best ADS Clinical Presentation Award in memory of Dr Paul Lee  Yes No

Are you currently a mid-career clinical researcher (4-10 year post-doctoral) Yes No

Supporting Document: