Lambda Chi Chapter
Submission Data for Podium/Poster Presentation
Preference: Podium, Poster, Either (circle one)
Podium/Poster title_______________________________________________________
Primary Author/Credentials________________________________________________
Position/Title
Agency Phone ( )
Home Address
City State Zip
E-mail ____________________________________________________________
Secondary Author(s)/Credentials ___________________________________________
Position/Title
Agency Phone ( )
Home Address
City State Zip
E-mail_________________________________________________
Who will present the podium/poster?
Abstracts may be printed on the program handouts and in audio/visual presentations. Please provide your electronic signature and date to indicate your permission for duplication of your abstract.
Signature Date