Abstract

Submission

Form

The 1st International Forum of Patient Safety 

                  by World Health Risk Management Center, Tokyo, Japan

(please type) 　　　to be held in Tokyo, January 23-24, 2006．

The committee requests your electronic submission by e-mail, till November 15, 2005.

This abstract form is available on http://www,urmpm.org/1PatSafe/

Please make sure that you provide all requested information as on this page. 

Abstracts sent by fax will not be accepted! 

　　

▲Authors                   

　

▲Name of the corresponding author

　

▲Organization

　

▲Mailing Address

　

▲Country

　

▲Phone (country code, area code, number)

　

Fax (country code, area code, number)

　

▲E-mail

Give maximally five keywords: 

1. 　　　　　       2. 　　　　　

3.       4. 　　　　　

5. 　　　　　

Title

Author(s)

Affiliation(s)           

E-mail address for corresponding author

Please fill the above 2 pages in this Abstract Form, and e-mail them to the Registration office shown in the below by October 15, 2005.  Before this abstract submission, you are requested to fax your Registration Form.  Remember to provide all information as requested on this Abstract Form.  The fax number appears in the Registration Form.

Please return this ABSTRACT FORM by e-mail to

the corresponding Registration Office:

Shirley V. V. Chaves

E-MAIL: secr-office@umin.ac.jp

TITTLE OF THE ABSTRACT MUST BE WRITTEN IN CAPITAL LETTER

Sample

Asbtract

Author(s)     Last name, Initial(s) (please an asterix* after the presenting authors)

Affiliation(s)  Institution, City and Country

        E-mail address:  secr-office@umin.ac.jp

STUDY PURPOSE:

MATERIALS & METHODS:

RESULT:

DISCUSION:

CONCLUSIONS:

The abstract text should be single-line, and written in English.

Font size is requested to be 10.5.