First Name *

Last Name *

Title *

Please include your professional title and year of residency or fellowship, if applicable. 

Address Line 1 *

Please provide your mailing address

Email *

Please include the best email address for us to use to reach you.

Authors/Investigators (list residents first): *

Authors/Investigators (list residents first):

Faculty Advisor (Resident Faculty advisors are required to be VSEPS members): *

Faculty Advisor (Resident Faculty advisors are required to be VSEPS members):

Type of Presentation (Select one) *

Type of Presentation (Select one)

Enter required value Poster Oral Presentation

Title of Research: *

Title of Research:

What is the purpose of your research? *

What is the purpose of your research?

Brief Description of Original Research *

Brief Description of Original Research

Brief Rationale and Needs Assessment: Describe the educational need for this research *

Brief Rationale and Needs Assessment: Describe the educational need for sharing your research with annual meeting attendees. What makes your research especially important to the general ophthalmologist? Has this research been done before? If so, makes your research different or unique? Is there a different process, approach or angle that you intend to pursue?

Methods: *

Please describe your method of research

Results *

Please discuss the results of your research. What were your findings?

Conclusion *

Conclusions - Please report any conclusions drawn during your research.

References: *

Please list three to five scientific resources (journals or other citations) for your research.

Support *

Please describe any support, such as grants, that you received for your research. This section will not replace the completed and signed disclosure form rrequired for all submissions. 

Conflict of interest *

Please describe any conflicts of interest you may have pertaining to your research. This section will NOT replace the completed and signed disclosure form rrequired for all submissions.

Please upload your current CV or resume *

20MB max

Please use this link to complete and sign your conflict disclosure form (Required) *

https://www.evms.edu/education/cme/for_the_activity_planner/disclosure_of_relationships_form/ 

For“Title of the Activity,”  put VA Society of Eye Physicians and Surgeons Annual Scientific Meeting 2025.