Title (Mr., Ms., Dr., etc):

* First name:

Middle Initial:

* Last name:

Organization:

* Mailing Address, first line:

Mailing Address, second line:

* City:

* State/Province:

* Zip/Postal Code:

* Country:

Telephone:

* E-Mail:

Please indicate the nature of your study
or type your abstract here
(you may send your abstract
and other information to
cendra@griefnet.org)

Please describe the steps
you will take to ensure the human
subject safeguards are adequately met:

You may include other pertinent information here: