P.R.E.M.I.E.R. Research Competition
Author Presenting
First Name:
Last Name:
Email
Phone:
Mailing Address:
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
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Hawaii
Idaho
Illinois
Indiana
Iowa
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Ohio
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South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Program Information
Please indicate your status:
PGY-1
PGY-2
PGY-3
Other
If other, please specify:
Family Medicine Residency Program:
Please select...
Desert Regional Medical Center Family Medicine Residency Program (Coachella Valley, Palm Springs)
Eisenhower Health Family Medicine Program
Kaiser Permanente Southern California Family Medicine - Fontana
Kaiser Permanente Southern California Family Medicine - Riverside
LifeLong Medical Care Family Medicine Residency Program
Loma Linda University Health Education Consortium Family Medicine Residency
Loma Linda University Murrieta Family Medicine Residency
Pomona Valley Hospital Family Medicine Residency Program
Riverside University Health System/UCR Family Medicine Residency Program
Southwest Healthcare MEC Family Medicine Residency Program Program
UC Riverside School of Medicine/St. Bernardine Medical Center – Dignity Health Program
OTHER
If other, please specify:
Program Director Name:
Program Director Email
Presentation Type
Category
Oral Research
Oral Case
Poster
Please attach your submission as a
PDF.
Posters must include a title and affiliation
Contact Information