2019 Program Committee AcceptanceStep 1: Contact InformationName* First Last Email*Please confirm your email for future correspondence. Assistant EmailPlease provide/confirm your assistant email for future correspondence. PhonePlease confirm your phone number.Step 2: Are you willing to participate on the 2019 Program Committee?Committee Acceptance:*Participation includes reviewing abstracts for the meeting at the beginning of 2019. Please mark this time frame on your calendar.Yes, I am ABLE to review abstracts and participate.Regrets, I am not able to participate on the committee.Will you attend and participate in the AHNS 2019 Annual Meeting at COSM taking place May 1-2, 2019 in Austin, TX?*Yes, I expect that I will be ABLE to attend the meeting.Regrets, I will not be able to attend the meeting.Step 3: CME DisclosureDisclosure of Financial Relationships*A commercial interest is defined as an entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.No. Neither I nor my spouse or partner have at present and/or have had within the last 12 months a financial relationship with a commercial interest.Yes. I and/or my spouse or partner have at present and/or have had within the last 12 months a financial relationship with a commercial interest.Financial Relationship(s):If you or your spouse/partner have at present and/or have had within the last 12 months a financial relationship with a commercial interest (A commercial interest is defined as an entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.), please list them below. To add additional lines, please click the + button to the right.Commercial Interest/CompanyFor What Role?What was Received?Myself and/or Spouse/Partner Step 4: Can you please tell us your areas of expertise?Please select 3 areas of expertise:* Cancer Biology Chemotherapy / Radiation / Adjuvant Treatment Education / Care Delivery Endocrine Surgery Functional Outcomes/Quality Health Services Research Hypopharynx/Larynx Imaging and Screening Nasopharynx/Paranasal Sinus/Skull Base Oral Cavity Oropharynx Reconstruction/Microvascular Surgery Salivary Gland Skin CancersStep 5: Will you be able to attend a committee meeting at the 2018 AHNS Meeting in April?RSVP for 2019 Program Committee Meeting at COSM:*Thursday, April 19, 2018 at 6:30 AM in Camellia Room at the Gaylord National ResortYes, I will attend the 2019 Program Committee meeting.No, I will not be able to attend this meeting.If a call in option were to become available, would you be able to call into the meeting?*Yes, I will be able to call in.No, I will not be able to call in.