43JSM Abstract Submission Form
Please fill in and return this form to the Congress Secretariat via e-mail
to by Friday, January 12th, 2018.
IMPORTANT:
Please note that the following information will be printed on the program and abstract book exactly as the type set as provided herein - your full name (Family name, Middle name, First name), name of your designated affiliation, title and main body of your abstract. Therefore, please check the information carefully before submission. Thank you for your attention.
Category(Required)：
☐ Basic research for pathogenesis and treatment of myeloma
☐ Clinical research for transplant-eligible patients
☐ Clinical research for patients not eligible for transplantation
☐ Clinical research for the management of adverse events and supportive care
☐ Basic and clinical research for amyloidosis, POEMS syndrome and other plasma cell dyscrasias
☐ Case reports
Presenting Author Name(Required)：
Family Name *： (e.g.) Smith
First Name *： (e.g.) John
Middle Name ： (e.g.) E
Birthday(Required)：
Enter your birth date
Institution 1 (Required)：(e.g.) Department of XXXX, University of XXXX, Japan
Telephone Number (Required)： +country code - area code – number (e.g.) +81-3-3508-1214
E-mail Address (Required)：
Co-authors (If any)
In case the co-authors' institution are different from the presenting author's, fill in the names of those institutions below.
Then input other authors' names and select the numbers to indicate the institution from the list below.
Please also indicate the authors’ order on the printed materials.
Institution 2
Institution 3
Institution 4
Institution 5
Institution 6
Institution 7
Institution 8
Institution 9
Institution 10
Author 2
Family Name:
First Name:
Middle Name:
Institution Number: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10
Author 3
Family Name:
First Name:
Middle Name:
Institution Number: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10
Author 4
Family Name:
First Name:
Middle Name:
Institution Number: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10
Author 5
Family Name:
First Name:
Middle Name:
Institution Number: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10
Author 6
Family Name:
First Name:
Middle Name:
Institution Number: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10
Author 7
Family Name:
First Name:
Middle Name:
Institution Number: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10
Author 8
Family Name:
First Name:
Middle Name:
Institution Number: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10
Author 9
Family Name:
First Name:
Middle Name:
Institution Number: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10
Author 10
Family Name:
First Name:
Middle Name:
Institution Number: ☐ 1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐ 6 ☐ 7 ☐ 8 ☐ 9 ☐ 10
Abstract Title (Required)：(100 characters or less and should be ALL CAPS)
Abstract Body (Required)：(approximately 1,600 characters)
Thank you for your cooperation!
Secretariat of the 43JSM
Kiyo Kim (Ms.)