XXXVII Pan-American Congress of Otolaryngology—Head and Neck Surgery - Call for Science Expert Lecture

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* 1. Proposal Title

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* 2. Submission Addresses

Present knowledge and approaches

State-of-the-art diagnosis and therapeutic approaches for patient care

Evidence-based data and expert opinion synthesis

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* 3. Specialty Area – Proposals must be submitted in one of the following subject areas that best describes your presentation:

Business of Medicine/Practice Management

Endocrine Surgery

Facial Plastic and Reconstructive Surgery

Comprehensive Otolaryngology

Head and Neck Surgery

Laryngology/Broncho-Esophagology

Otology/Neurotology

Patient Safety and Quality Improvement

Pediatric Otolaryngology

Professional and Personal Development

Rhinology/Allergy

Sleep Medicine

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* 4. PROGRAM DESCRIPTION - Provide a concise description that will explain the focus and significance of your proposed session. You should provide a description of the relevance of this program to the practice of otolaryngology and the purpose (goals) of the presentation. If selected, your description will be published online to help attendees choose among sessions.

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* 5. OUTCOME OBJECTIVES – Objectives focus participants’ attention on the expected behavioral outcomes from the presentation. You should state clearly what attendees should be able to practice upon completion of the session. Begin each statement with a verb (i.e., analyze, compare, demonstrate, examine, explain, implement, interpret, recognize, etc.). If selected, your objectives will be published online to help attendees choose among sessions.

Objective #1

Objective #2

Objective #3

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* 6. BACKGROUND STATEMENT – provide a short statement explaining why this topic should be addressed at the Pan American Congress. What general clinical or patient need led you to submit this abstract? The background statement is an opportunity to provide additional information to the Program Committee on the clinical relevance or timeliness of your presentation. The text will not be published and is for the use of the selection committee. Review and click Submit.

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* 7. Submitter Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 8. Are all presenters a minimum of five years out of residency?

Yes

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* 9. Lead Presenter Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 10. Lead Presenter Disclosure: The Pan-American Congress supports fair and unbiased participation of our volunteers in activities. Any actual or potential conflicts of interest must be identified and managed. All direct financial and intellectual relationships with a company that directly impact and/or might conflict with Congress activities must be disclosed, or you must disclose that you have no direct financial relationships. Other relationships that could cause private interests to conflict with professional interests must also be identified. This policy is intended to openly identify any potential conflict so that any potential bias may be identified and the risk thereof mitigated. Failure or refusal to complete the disclosure form or disclose all relevant relationships will result in disqualification to participate in the Pan-American Congress.

I have no financial or intellectual relationships to disclose over the past 36 months

I have the following financial and/or intellectual relationship(s) to disclose over the past 36 months

Financial and/or intellectual relationship(s) to disclose. Examples: Salary; Royalty; Consulting Fee; Honoraria; Stock or Stock Options; Intellectual Property Rights; Research Funding; Other

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* 11. Co-Presenter Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 12. Co-Presenter Disclosure: The Pan-American Congress supports fair and unbiased participation of our volunteers in activities. Any actual or potential conflicts of interest must be identified and managed. All direct financial and intellectual relationships with a company that directly impact and/or might conflict with Congress activities must be disclosed, or you must disclose that you have no direct financial relationships. Other relationships that could cause private interests to conflict with professional interests must also be identified. This policy is intended to openly identify any potential conflict so that any potential bias may be identified and the risk thereof mitigated. Failure or refusal to complete the disclosure form or disclose all relevant relationships will result in disqualification to participate in the Pan-American Congress.

I have no financial or intellectual relationships to disclose over the past 36 months

I have the following financial and/or intellectual relationship(s) to disclose over the past 36 months

Financial and/or intellectual relationship(s) to disclose. Examples: Salary; Royalty; Consulting Fee; Honoraria; Stock or Stock Options; Intellectual Property Rights; Research Funding; Other