2023 IADR/LAR with WCPD Abstract Withdraw, Presenter Change, and Refund Request Form | IADR - International Association of Dental Research

2023 IADR/LAR General Session with WCPD - Abstract Withdraw, Presenter Change, and Refund Request Form

Are you an Abstract Presenter?

Yes

Current Presenter Full Name:

First Name

Last Name

Abstract ID#:

Email:

Select Requested Action

Presenter Change

Withdraw

Neither

Replacement Presenter Full Name:

First Name

Last Name

Replacement Presenter Email:

Replacement Presenter Phone Number:

For Student Replacements please select category:

FOR THE REPLACEMENT PRESENTER ONLY:

Please confirm the following information: Does the replacement presenter have a significant financial interest/arrangement or affiliation with an organization/institution whose products or services are being discussed in this session. This information must be disclosed to the participants who attend my presentation.

Yes

If the answer to the above is Yes, please provide the organization/institution name and speaker relationship to the organization/institution.

Reason for withdraw/presenter change:

Full Name

Do you need to request refund/cancel your registration?

Please note registration cancellations will be considered based on the deadline dates outlined in the meeting refund policy located on the meeting page

Yes

Registration ID:

Reason for registration cancellation/refund:

Based on your selections, there is no need for you to submit this form. If you intend to change your abstract or cancel your registration please review your above selections before submission.

Based on your selections, there is no need for you to submit this form. If you intend to change your abstract or cancel your registration, please review your above selections before submission.

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