AHNS 2020 Local Representative Acceptance2020 Local Reps Role Acceptance Step 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 as a Local Rep for AHNS 10th International Conference?Committee Acceptance:*Participation includes reviewing abstracts for the meeting at the beginning of 2020. 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 10th International Conference on Head & Neck Cancer taking place July 18-22, 2020 in Chicago, Illinois?*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 for review purposes?Please select your 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 Cancers Share:FacebookTwitterLinkedIn