AHNS Program Content Suggestions - American Head & Neck Society

Please use the form below to submit suggested panel topics.
Please note that due to space and time restrictions, we cannot include all submitted suggestions. We highly value all content ideas and will do our best to incorporate all topics that fit the meeting theme and interest of our members.

If you have any questions, please contact [email protected].

Name(Required)

First Last

Email(Required)

Please disclose all financial relationships that you have had in the past 24 months with ineligible companies, even if not related to the topic of the activity. An ineligible company is any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Do you have any relationships to disclose?(Required)

No, I do not have and/or have not had within the last 24 months a financial relationship with an ineligible company.

Yes, I have and/or have had within the last 24 months a financial relationship with an ineligible company as listed below.

Ineligible Company Name(s):(Required)

Nature of the Financial Relationship(s):(Required)

Organizing Body:(Required)

Please let us know on behalf of which service, section, or division you are submitting from. If this is an individual suggestion, please put "N/A".

Panel Topic:(Required)

Panel Title:(Required)

Panel Description:(Required)

Suggested Moderator(s) & Panelists for Panel:

Please identify the suggested moderator(s) and panelists you envision participating on this panel. Under Role, please type 'Moderator' or 'Panelist'.

Role

Name

Institution

Phone

This field is for validation purposes and should be left unchanged.

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