CINXE.COM
Online submission Form - ICABME Conference
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class="top_wrapper"> <!-- .header --> <!-- Page Head --> <div data-rocket-location-hash="2d39b45dfab8ae2d9573198cc29809cc" class="header_page normal no_parallax"> <div class="container"> <h1>Online submission Form</h1> <span class="divider"></span> <div class="breadcrumbss"> <ul class="page_parents pull-right"> <li>You are here: </li> <li class="home"><a href="https://www.icabme.org">Home</a></li> <li class="active"><a href="https://www.icabme.org/online-submission-form/">Online submission Form</a></li> </ul> </div> </div> </div> <section data-rocket-location-hash="e605f35eac7267a3f4144211df3cbb4e" id="content" class="composer_content " style="background-color:#ffffff;"> <div class="container sidebar_right" id="blog"> <div class="row"> <div class="span9"> <div class="wpb-content-wrapper"><div id="fws_674662c39bc5e" class="vc_row wpb_row vc_row-fluid animate_onoffset row-dynamic-el standard_section " style="" ><div style="position: absolute;top: 0;"></div><div class="container dark"><div class="section_clear"> <div class="vc_col-sm-12 wpb_column column_container " style="" data-animation="none" data-delay=""> <div class="wpb_wrapper"> <div class="wpb_text_column wpb_content_element "> <div class="wpb_wrapper" > <h2>Online submission</h2> </div> </div> <div class='gf_browser_ie gf_browser_ie7 gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_51' ><form method='post' enctype='multipart/form-data' id='gform_51' action='/online-submission-form/' data-formid='51' novalidate> <div class='gform-body gform_body'><ul id='gform_fields_51' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id="field_51_23" class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_23" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Prefix<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_51_23'><li class='gchoice gchoice_51_23_1'> <input class='gfield-choice-input' name='input_23.1' type='checkbox' value='Prof. Dr.' id='choice_51_23_1' /> <label for='choice_51_23_1' id='label_51_23_1' class='gform-field-label gform-field-label--type-inline'>Prof. Dr.</label> </li><li class='gchoice gchoice_51_23_2'> <input class='gfield-choice-input' name='input_23.2' type='checkbox' value='Dr.' id='choice_51_23_2' /> <label for='choice_51_23_2' id='label_51_23_2' class='gform-field-label gform-field-label--type-inline'>Dr.</label> </li><li class='gchoice gchoice_51_23_3'> <input class='gfield-choice-input' name='input_23.3' type='checkbox' value='MSC.' id='choice_51_23_3' /> <label for='choice_51_23_3' id='label_51_23_3' class='gform-field-label gform-field-label--type-inline'>MSC.</label> </li><li class='gchoice gchoice_51_23_4'> <input class='gfield-choice-input' name='input_23.4' type='checkbox' value='MD.' id='choice_51_23_4' /> <label for='choice_51_23_4' id='label_51_23_4' class='gform-field-label gform-field-label--type-inline'>MD.</label> </li><li class='gchoice gchoice_51_23_5'> <input class='gfield-choice-input' name='input_23.5' type='checkbox' value='Mrs.' id='choice_51_23_5' /> <label for='choice_51_23_5' id='label_51_23_5' class='gform-field-label gform-field-label--type-inline'>Mrs.</label> </li><li class='gchoice gchoice_51_23_6'> <input class='gfield-choice-input' name='input_23.6' type='checkbox' value='Ms.' id='choice_51_23_6' /> <label for='choice_51_23_6' id='label_51_23_6' class='gform-field-label gform-field-label--type-inline'>Ms.</label> </li><li class='gchoice gchoice_51_23_7'> <input class='gfield-choice-input' name='input_23.7' type='checkbox' value='Mr.' id='choice_51_23_7' /> <label for='choice_51_23_7' id='label_51_23_7' class='gform-field-label gform-field-label--type-inline'>Mr.</label> </li><li class='gchoice gchoice_51_23_8'> <input class='gfield-choice-input' name='input_23.8' type='checkbox' value='Rev.' id='choice_51_23_8' /> <label for='choice_51_23_8' id='label_51_23_8' class='gform-field-label gform-field-label--type-inline'>Rev.</label> </li></ul></div></li><li id="field_51_21" class="gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_21" ><label class='gfield_label gform-field-label' for='input_51_21'>First Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_51_21' type='text' value='' class='large' aria-required="true" aria-invalid="false" /></div></li><li id="field_51_24" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_24" ><label class='gfield_label gform-field-label' for='input_51_24'>Middle Name</label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_51_24' type='text' value='' class='large' aria-invalid="false" /></div></li><li id="field_51_22" class="gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_22" ><label class='gfield_label gform-field-label' for='input_51_22'>Last Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_51_22' type='text' value='' class='large' aria-required="true" aria-invalid="false" /></div></li><li id="field_51_3" class="gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_3" ><label class='gfield_label gform-field-label' for='input_51_3'>Institution<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_51_3' type='text' value='' class='large' aria-required="true" aria-invalid="false" /></div></li><li id="field_51_17" class="gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_17" ><label class='gfield_label gform-field-label' for='input_51_17'>Country<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_51_17' class='large gfield_select' aria-required="true" aria-invalid="false" ><option value='' selected='selected' class='gf_placeholder'>Select</option><option value='Afghanistan' >Afghanistan</option><option value='Albania' >Albania</option><option value='Algeria' >Algeria</option><option value='American Samoa' >American Samoa</option><option value='Andorra' >Andorra</option><option value='Angola' >Angola</option><option value='Antigua and Barbuda' >Antigua and Barbuda</option><option value='Argentina' >Argentina</option><option value='Armenia' >Armenia</option><option value='Australia' >Australia</option><option value='Austria' >Austria</option><option value='Azerbaijan' >Azerbaijan</option><option value='Bahamas' >Bahamas</option><option value='Bahrain' >Bahrain</option><option value='Bangladesh' >Bangladesh</option><option value='Barbados' >Barbados</option><option value='Belarus' >Belarus</option><option value='Belgium' >Belgium</option><option value='Belize' >Belize</option><option value='Benin' >Benin</option><option value='Bermuda' >Bermuda</option><option value='Bhutan' >Bhutan</option><option value='Bolivia' >Bolivia</option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina</option><option value='Botswana' >Botswana</option><option value='Brazil' >Brazil</option><option value='Brunei' >Brunei</option><option value='Bulgaria' >Bulgaria</option><option value='Burkina Faso' >Burkina Faso</option><option value='Burundi' >Burundi</option><option value='Cambodia' >Cambodia</option><option value='Cameroon' >Cameroon</option><option value='Canada' >Canada</option><option value='Cape Verde' >Cape Verde</option><option value='Cayman Islands' >Cayman Islands</option><option value='Central African Republic' >Central African Republic</option><option value='Chad' >Chad</option><option value='Chile' >Chile</option><option value='China' >China</option><option value='Colombia' >Colombia</option><option value='Comoros' >Comoros</option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the</option><option value='Congo, Republic of the' >Congo, Republic of the</option><option value='Costa Rica' >Costa Rica</option><option value='Côte d'Ivoire' >Côte d'Ivoire</option><option value='Croatia' >Croatia</option><option value='Cuba' >Cuba</option><option value='Curaçao' >Curaçao</option><option value='Cyprus' >Cyprus</option><option value='Czech Republic' >Czech Republic</option><option value='Denmark' >Denmark</option><option value='Djibouti' >Djibouti</option><option value='Dominica' >Dominica</option><option value='Dominican Republic' >Dominican Republic</option><option value='East Timor' >East Timor</option><option value='Ecuador' >Ecuador</option><option value='Egypt' >Egypt</option><option value='El Salvador' >El Salvador</option><option value='Equatorial Guinea' >Equatorial Guinea</option><option value='Eritrea' >Eritrea</option><option value='Estonia' >Estonia</option><option value='Ethiopia' >Ethiopia</option><option value='Faroe Islands' >Faroe Islands</option><option value='Fiji' >Fiji</option><option value='Finland' >Finland</option><option value='France' >France</option><option value='French Polynesia' >French Polynesia</option><option value='Gabon' >Gabon</option><option value='Gambia' >Gambia</option><option value='Georgia' >Georgia</option><option value='Germany' >Germany</option><option value='Ghana' >Ghana</option><option value='Greece' >Greece</option><option value='Greenland' >Greenland</option><option value='Grenada' >Grenada</option><option value='Guam' >Guam</option><option value='Guatemala' >Guatemala</option><option value='Guinea' >Guinea</option><option value='Guinea-Bissau' >Guinea-Bissau</option><option value='Guyana' >Guyana</option><option value='Haiti' >Haiti</option><option value='Honduras' >Honduras</option><option value='Hong Kong' >Hong Kong</option><option value='Hungary' >Hungary</option><option value='Iceland' >Iceland</option><option value='India' >India</option><option value='Indonesia' >Indonesia</option><option value='Iran' >Iran</option><option value='Iraq' >Iraq</option><option value='Ireland' >Ireland</option><option value='Israel' >Israel</option><option value='Italy' >Italy</option><option value='Jamaica' >Jamaica</option><option value='Japan' >Japan</option><option value='Jordan' >Jordan</option><option value='Kazakhstan' >Kazakhstan</option><option value='Kenya' >Kenya</option><option value='Kiribati' >Kiribati</option><option value='North Korea' >North Korea</option><option value='South Korea' >South Korea</option><option value='Kosovo' >Kosovo</option><option value='Kuwait' >Kuwait</option><option value='Kyrgyzstan' >Kyrgyzstan</option><option value='Laos' >Laos</option><option value='Latvia' >Latvia</option><option value='Lebanon' >Lebanon</option><option value='Lesotho' >Lesotho</option><option value='Liberia' >Liberia</option><option value='Libya' >Libya</option><option value='Liechtenstein' >Liechtenstein</option><option value='Lithuania' >Lithuania</option><option value='Luxembourg' >Luxembourg</option><option value='Macedonia' >Macedonia</option><option value='Madagascar' >Madagascar</option><option value='Malawi' >Malawi</option><option value='Malaysia' >Malaysia</option><option value='Maldives' >Maldives</option><option value='Mali' >Mali</option><option value='Malta' >Malta</option><option value='Marshall Islands' >Marshall Islands</option><option value='Mauritania' >Mauritania</option><option value='Mauritius' >Mauritius</option><option value='Mexico' >Mexico</option><option value='Micronesia' >Micronesia</option><option value='Moldova' >Moldova</option><option value='Monaco' >Monaco</option><option value='Mongolia' >Mongolia</option><option value='Montenegro' >Montenegro</option><option value='Morocco' >Morocco</option><option value='Mozambique' >Mozambique</option><option value='Myanmar' >Myanmar</option><option value='Namibia' >Namibia</option><option value='Nauru' >Nauru</option><option value='Nepal' >Nepal</option><option value='Netherlands' >Netherlands</option><option value='New Zealand' >New Zealand</option><option value='Nicaragua' >Nicaragua</option><option value='Niger' >Niger</option><option value='Nigeria' >Nigeria</option><option value='Northern Mariana Islands' >Northern Mariana Islands</option><option value='Norway' >Norway</option><option value='Oman' >Oman</option><option value='Pakistan' >Pakistan</option><option value='Palau' >Palau</option><option value='Palestine, State of' >Palestine, State of</option><option value='Panama' >Panama</option><option value='Papua New Guinea' >Papua New Guinea</option><option value='Paraguay' >Paraguay</option><option value='Peru' >Peru</option><option value='Philippines' >Philippines</option><option value='Poland' >Poland</option><option value='Portugal' >Portugal</option><option value='Puerto Rico' >Puerto Rico</option><option value='Qatar' >Qatar</option><option value='Romania' >Romania</option><option value='Russia' >Russia</option><option value='Rwanda' >Rwanda</option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis</option><option value='Saint Lucia' >Saint Lucia</option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines</option><option value='Samoa' >Samoa</option><option value='San Marino' >San Marino</option><option value='Sao Tome and Principe' >Sao Tome and Principe</option><option value='Saudi Arabia' >Saudi Arabia</option><option value='Senegal' >Senegal</option><option value='Serbia' >Serbia</option><option value='Seychelles' >Seychelles</option><option value='Sierra Leone' >Sierra Leone</option><option value='Singapore' >Singapore</option><option value='Sint Maarten' >Sint Maarten</option><option value='Slovakia' >Slovakia</option><option value='Slovenia' >Slovenia</option><option value='Solomon Islands' >Solomon Islands</option><option value='Somalia' >Somalia</option><option value='South Africa' >South Africa</option><option value='Spain' >Spain</option><option value='Sri Lanka' >Sri Lanka</option><option value='Sudan' >Sudan</option><option value='Sudan, South' >Sudan, South</option><option value='Suriname' >Suriname</option><option value='Swaziland' >Swaziland</option><option value='Sweden' >Sweden</option><option value='Switzerland' >Switzerland</option><option value='Syria' >Syria</option><option value='Taiwan' >Taiwan</option><option value='Tajikistan' >Tajikistan</option><option value='Tanzania' >Tanzania</option><option value='Thailand' >Thailand</option><option value='Togo' >Togo</option><option value='Tonga' >Tonga</option><option value='Trinidad and Tobago' >Trinidad and Tobago</option><option value='Tunisia' >Tunisia</option><option value='Turkey' >Turkey</option><option value='Turkmenistan' >Turkmenistan</option><option value='Tuvalu' >Tuvalu</option><option value='Uganda' >Uganda</option><option value='Ukraine' >Ukraine</option><option value='United Arab Emirates' >United Arab Emirates</option><option value='United Kingdom' >United Kingdom</option><option value='United States' >United States</option><option value='Uruguay' >Uruguay</option><option value='Uzbekistan' >Uzbekistan</option><option value='Vanuatu' >Vanuatu</option><option value='Vatican City' >Vatican City</option><option value='Venezuela' >Venezuela</option><option value='Vietnam' >Vietnam</option><option value='Virgin Islands, British' >Virgin Islands, British</option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.</option><option value='Yemen' >Yemen</option><option value='Zambia' >Zambia</option><option value='Zimbabwe' >Zimbabwe</option></select></div></li><li id="field_51_29" class="gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_29" ><label class='gfield_label gform-field-label' for='input_51_29'>Phone Number<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_29' id='input_51_29' type='tel' value='' class='large' aria-required="true" aria-invalid="false" /></div></li><li id="field_51_30" class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible" data-js-reload="field_51_30" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Phone Agreement</label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_51_30'><li class='gchoice gchoice_51_30_1'> <input class='gfield-choice-input' name='input_30.1' type='checkbox' value='I would also like to receive notifications via SMS.' id='choice_51_30_1' /> <label for='choice_51_30_1' id='label_51_30_1' class='gform-field-label gform-field-label--type-inline'>I would also like to receive notifications via SMS.</label> </li></ul></div></li><li id="field_51_26" class="gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_26" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Corresponding Author's email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_51_26_container'> <span id='input_51_26_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'> <input class='' type='email' name='input_26' id='input_51_26' value='' aria-required="true" aria-invalid="false" /> <label for='input_51_26' class='gform-field-label gform-field-label--type-sub '>Enter Email</label> </span> <span id='input_51_26_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'> <input class='' type='email' name='input_26_2' id='input_51_26_2' value='' aria-required="true" aria-invalid="false" /> <label for='input_51_26_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email</label> </span> <div class='gf_clear gf_clear_complex'></div> </div></li><li id="field_51_8" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_8" ><label class='gfield_label gform-field-label' for='input_51_8'>Co-Authors Names</label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_51_8' type='text' value='' class='large' aria-invalid="false" /></div></li><li id="field_51_9" class="gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_9" ><label class='gfield_label gform-field-label' for='input_51_9'>Paper Title<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_51_9' type='text' value='' class='large' aria-required="true" aria-invalid="false" /></div></li><li id="field_51_19" class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_hidden" data-js-reload="field_51_19" ><div class="admin-hidden-markup"><i class="gform-icon gform-icon--hidden" aria-hidden="true" title="This field is hidden when viewing the form"></i><span>This field is hidden when viewing the form</span></div><label class='gfield_label gform-field-label gfield_label_before_complex' >Type of Presentation<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='gfield_description' id='gfield_description_51_19'>"The Scientific Committee reserves the right to decide the final type of presentation"</div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_51_19'><li class='gchoice gchoice_51_19_1'> <input class='gfield-choice-input' name='input_19.1' type='checkbox' value='Oral presentation' id='choice_51_19_1' aria-describedby="gfield_description_51_19"/> <label for='choice_51_19_1' id='label_51_19_1' class='gform-field-label gform-field-label--type-inline'>Oral presentation</label> </li><li class='gchoice gchoice_51_19_2'> <input class='gfield-choice-input' name='input_19.2' type='checkbox' value='Poster Presentation' id='choice_51_19_2' /> <label for='choice_51_19_2' id='label_51_19_2' class='gform-field-label gform-field-label--type-inline'>Poster Presentation</label> </li><li class='gchoice gchoice_51_19_3'> <input class='gfield-choice-input' name='input_19.3' type='checkbox' value='Virtual Presentation' id='choice_51_19_3' /> <label for='choice_51_19_3' id='label_51_19_3' class='gform-field-label gform-field-label--type-inline'>Virtual Presentation</label> </li></ul></div></li><li id="field_51_31" class="gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" data-js-reload="field_51_31" ><label class='gfield_label gform-field-label' >Type of Presentation<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='gfield_description' id='gfield_description_51_31'>"The Scientific Committee reserves the right to decide the final type of presentation"</div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_51_31'> <li class='gchoice gchoice_51_31_0'> <input name='input_31' type='radio' value='Oral/Poster Presentation' id='choice_51_31_0' /> <label for='choice_51_31_0' id='label_51_31_0' class='gform-field-label gform-field-label--type-inline'>Oral/Poster Presentation</label> </li> <li class='gchoice gchoice_51_31_1'> <input name='input_31' type='radio' value='Virtual Presentation' id='choice_51_31_1' /> <label for='choice_51_31_1' id='label_51_31_1' class='gform-field-label gform-field-label--type-inline'>Virtual Presentation</label> </li></ul></div></li><li id="field_51_11" class="gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible" data-js-reload="field_51_11" ><label class='gfield_label gform-field-label' for='input_51_11'>Abstract<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_51_11' class='textarea medium' aria-required="true" aria-invalid="false" rows='10' cols='50'></textarea></div></li><li id="field_51_10" class="gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below 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