Undertaking for Competition Awards of APSI

I the undersigned wish to present my paper titled ------------------------------------------------ in the ----------

------category ------------------------( Peet Prize/APSI best paper/Kilner Essay Award/ PGIMER I T Jackson
cleft and Craniofacial award ) in APSICON ( year) .

I hereby declare that this paper has not been published either partly or in full or sent for publication
in any of the Journals.

Or

I hereby declare that this paper has been partly published in ---------------------------Journal. The
published article is attached hereto.

In the event that it is noticed that the undertaking is untrue I am aware that my paper will not be
considered for competition award. In case it is noticed post facto the award will be withdrawn and I
will not be permitted to compete in awards sessions of APSICONS for period of next 3 years.