Clinical and Research Annual Prize Competition Illinois Chapter, American College of Cardiology October 8, 2004 Hilton Chicago 720 S. Michigan Avenue Chicago, Illinois 60605 Poster Viewing 5:00 - 6:30 pm Note: All fields must be completed for submission to be valid.. This is to confirm that I wish to enter a poster in the following category (check one): I. Case Presentation — First Prize $500, Second Prize $250 II. Basic Research — First Prize $500, Second Prize $250 III. Clinical Research — First Prize $500, Second Prize $250 Name Co-authors If no co-author, please enter None Institution Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming     ZIP Daytime Phone xxx-xxx-xxxx Daytime Fax xxx-xxx-xxxx Dr. at the has reviewed this application and supports its submission. Poster Abstract or Outline — 300 words or fewer: Deadline: September 24, 2004 Submission under my e-mail address attests that this work is original, has substantial intellectual contribution from its authors, and has been reviewed by my attending cardiologist. All Poster Presenters must be personally present during viewing hours. Submit to: Peter J. Stecy, MD, FACC Co-Chair, Illinois Chapter Awards Committee Illinois Masonic Medical Center