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To comittee of Research Poster Online Competition SYNOVIA 2021,

Hereby, We, the undersigned,

First author :
Second author :
Third author :
Fourth author :
Fifth author :

Institution :

state that Research/Case report/Systematic Review with or without Meta-analysis/


Literature Reviewentitled:
“ …(insert your title)…”

is an original work of the authors above. This paper has not been published or presented in any
competition, congress, or any other events and platforms out of Research Poster Online
Competition 209 Doctor’s Oath Symposium SYNOVIA 2021.

Authors understand and agree to be fully responsible for the content of this paper.Should there
be any violation related to this work, authors are ready to be disqualified from our research poster
competition.

(Place) ,(Date)

Signature

(First Author Name)(Second Author Name)(Third Author Name)

*choose one
Note: This form could be electronically signed and could be saved as PDF format

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