Southern Illinois University School of Medicine

$SIU School of Medicine\$

Newsletter Submission Form

This information provided from this submission will be used to publish a professional presentation, publication or honor in the School's bi-weekly Newsletter. For questions, contact Merle Shiffman, Communications Coordinator, Public Affairs, 545-5616.

Name:	E-mail:
Department:	Phone:
Title or Position:
Please fill in all the information for the appropriate section you are submitting
Presentation Title:
Location: Organization: Date:

Publication Title: Journal Name: Page number: Volume number:

State or National Honor/Award Name:
Location/Date:
Organization: Reason for honor: