Spine Society of Australia ASM 2016 Author & Co-Author Declaration of Interest

Author / co-author details

For each submitted abstract for the SSA 27th ASM, all authors (including all co-authors) are required to complete their own Declaration of Interest by Friday 15 January 2016. Papers missing a Declaration of Interest from all author or co-author will be withdrawn from the program.

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* 1. Abstract ID number?

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* 2. I have submitted this abstract and am the presenting author.

Yes, I am the presenting author

No, I am a co-author

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* 3. Please enter your FIRST name (as it appears on the abstract).

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* 4. Please enter your FAMILY name (as it appears on the abstract).

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* 5. Position?

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* 6. Professional discipline?

Neurosurgery

Orthopaedics

Spine Surgery

Medical Engineer

Other

Other (please specify)

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* 7. Organisation or affiliation?

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* 8. Email address?

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* 9. Please indicate below if you have any declaration of interest?

No, I have nothing to declare

Yes, I need to state a declaration of interest