If you have any difficulties completing this form, please get in touch with Paul Cassidy at scientific@isa2019madrid.com

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Email^*

First Name^*

Last Name^*

Step 1. Speaker details

Please complete your personal and professional details. These details will be provided to EACCME for the accreditation process. The details you provided in your User Account are autofilled.

Profession/expertise 1^*

Profession/expertise 2

Affiliation 1: Organisation type^*

Affiliation 1 Name^*

Affiliation 1 Position^*

Affiliation 2: Organisation type

Affiliation 2 Name

Affiliation 2 Position

Address line 1^*

Address line 2

City/town^*

State/county^*

Zip/postcode

Country^*

Phone number (work)

Phone (mobile)^*

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Step 3. Learning outcomes

For the purposes of academic accreditation, each speaker must provide 3 learning outcomes for their presentation.

An example of a learning outcome is:

- Delegates will be able to understand the key components of respectful perinatal bereavement care
- Delegates will learn how to support parents to make a decision about perinatal autopsy
- Delegates will know when and why a placental examination
- Delegates will develop the skills to effectively communicate with bereaved parents

Useful action verbs: classify, describe, discuss, explain, express, interpret, differentiate, discuss, recognize, understand, distinguish, apply, demonstrate, practice, empathise, employ, interpret, examine, relate, analyze, categorize, compare, contrast, discriminate, distinguish, examine, question, separate, classify, support, evaluate, resolve

Please write 3 learning outcomes for your presentation. The scientific committee will review them and suggest changes if necessary.

Learning outcome 1^*

Learning outcome 2^*

Learning outcome 3^*

Step 2. Enter abstract Title, Body and Keywords

We recommend copying and pasting your abstract here, rather than typing it in.

Abstract title length is set at 150 characters and abstract body length is set at 2,000 characters, spaces included (approx. 300 words). If your abstract title or body length exceeds these limits it will be automatically reduced to the set limits. As such, it is advisable to do a character count on your word processor before pasting.

Abstracts must have 3 clearly identified and numbered sections:

1) Introduction - short introduction to the key area(s) to be covered
2) Description - description of the main content of the presentation
3) Summary - key ideas/ takeaways

Please do not include references in the abstract, however you can include up to 5 recommended readings in the following section, which we are sure would be appreciated by delegates.

The abstract should be written as a publishable text and not use language such as “the presentation will address…”

Abstract Title^*

Abstract body

Keywords^*

Step 4. Suggested reading

This is an optional section.

If you wish you can include up to 5 articles, chapters or books for suggested reading.

We will make the reading lists for each session available to all delegates through the “Delegate Area” during the conference.

Step 5. Declaration of competing interests

It is the policy of the International Stillbirth Alliance to ensure that all scientific content is balanced, independent, objective and methodologically rigorous. Consequently, all speakers are expected to disclose any real or potential competing interests or affiliations that may have a bearing on the subject matter of their presentation. Relevant affiliations or funding sources include, but are not limited to:

- manufacturers or marketers of biomedical devices;
- pharmaceutical companies.

Do you have any actual or potential conflicts of interest to declare?^*

Specify competing interests:

Step 6. Permission for live streaming and recording of presentations

As you were advised in your formal invitation letter, ISA2019 will be live streamed for the first time and most presentations will be recorded to allow online delegates who cannot view live content (for example, due to time zone differences) to catch up or in the case of in-person delegates to view material from parallel session that they missing during the conference.

It is envisaged that this recorded content will be available to all delegates online for a period of 2 months. The material will only be available for paid up delegates in a password protected area of the conference website or associated streaming/video platforms and will never be published on any other platform.

Permission for live streaming and recording:^*

I give permission for my presentation at ISA2019 Madrid to be live streamed, recorded and made available for a period of 2 months on the conference website and/or associated streaming/video platforms
I do not give permission for my presentation at ISA2019 Madrid to be live streamed, recorded and made available for a period of 2 months on the conference website and/or associated streaming/video platforms