AHNS 2020 Course Chair AcceptanceAHNS 2020 Course Chair Acceptance Section 1: Contact InformationName* First Last Email* Assistant E-mailPlease provide your assistant email for future correspondencePhonePlease confirm your phone number.Section 2: Course Chair InfoCourse Chair Acceptance*Will you attend and accept the role as Course Chair in the 10th International Conference on Head & Neck Cancer taking place July 18-22, 2020 in Chicago, ILYes, I expect to attend and accept my role as Course ChairRegrets, I will not be able to attendCourse Faculty RecommendationAs we are putting together the program, we would like to consider any suggestions you might have for course faculty at the 10th International Conference on Head & Neck Cancer. Please complete the information below.First NameLast NameE-mail Section 3: CME DisclosureDisclosure of Financial Relationship*A commercial interest is defined as an entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patientsNo. 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 Relationships:*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 then 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 If there are any questions, please contact Christine Sass at Christines@AHNS.info