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Committee Guidelines

 

  • All committee members shall be in good standing with the Academy. They must be a voting fellow, member, resident member, scientific fellow, international fellow, or international member of the Academy to be eligible to serve as a committee member. Non-voting members may be appointed as consultants to an AAO-HNS/F committee.
  • Committee members must have an email address they use daily and web access.
  • Committee chairs and members typically serve on a committee for two (2) consecutive two-year terms, with a third reappointment granted in special circumstances. Consultants are appointed for one two-year term.
  • Committee members completing their term are advised to contact the chair and/or co-chair expressing an interest in being reappointed.
  • Members, who have served six consecutive years on a committee, must wait two years before reapplying to the same committee.
  • AAO-HNS/F policy limits the number of committees on which one can participate concurrently to no more than two committees.
  • For full listing of committee guidelines, click here..

 
Applicant Name and Address
* Required fields.
 
AAO-HNS ID No:
To auto complete your information, enter your AAO-HNS ID, and last name then click the "Auto Complete" button.
*Email Address
Re-enter Email to Confirm  
*Family Name/Last Name
*First Name
Middle Initial
Suffix/Degree
*Address Line 1
Address Line 2
Address Line 3
*City
State/Province
If other enter here 
Zip+4/Postal Code
*Country
If other enter here 
*Telephone Number  (Include country and city/area code)
Fax Number
 
* Are you a Resident
Member or a Fellow In-Training? 		Yes       No
 
Committees of Interest
 
Please list up to three (3) committees to which you would like to be appointed, in order of preference. Following each committee, please include a brief summary of any experience, professional specialty involvement, society membership, background, or study that would qualify you for membership on the committee requested.
 

NOTE: BOG, Education, and WIO Committees are now included with the general committee applications. Be sure to select your choices carefully as many committees have similar names.

*1st Committee Choice:
Brief Summary (100 words):

WORD COUNT 
If you have ever attended this Committee Meeting as a guest, please check here :
 
 
 
2nd Committee Choice:
Brief Summary (100 words):

WORD COUNT 
If you have ever attended this Committee Meeting as a guest, please check here :
 
 
 
3rd Committee Choice:
Brief Summary (100 words):

WORD COUNT 
If you have ever attended this Committee Meeting as a guest, please check here :
 
Due to limited vacancies on each committee, we cannot guarantee appointment to any of your choices.
If you are willing to serve on other committees/subcommittees that relate to your field of expertise, please check here :

Society Representation
 
Are you applying as a Society Representative? Yes No
 
Note: If you have been identified by your specialty society as its Society Representative designee, please indicate this in the Brief Summary section
 
Additional Information
 
What is your academic, hospital, or work affiliation and position? (250 words)
WORD COUNT 
 
What other otolaryngology and non-otolaryngology volunteer organizations do you participate in? (250 words)
WORD COUNT 
 
List any honors, awards, recognition or publication/presentations that qualify you to be appointed to an AAO-HNS/F committee. (250 words)
WORD COUNT 
 
What do you hope to get out of your volunteer experience? (250 words)
WORD COUNT 
 
Please list any additional information you'd like to offer. (250 words)
WORD COUNT 
 
Conflict of Interest/Financial Relationship Disclosure
 
Statement of Purpose: The American Academy of Otolaryngology - Head and Neck Surgery/Foundation (AAO-HNS/F) supports fair and unbiased participation of our volunteers in Academy/Foundation activities. Any real or potential conflicts of interest must be identified and managed. All relevant financial relationships with commercial interests that directly impact and/or might conflict with Academy/Foundation activities must be disclosed, or disclosure that you have no relevant financial relationships must be documented. Other relationships that could cause private interests to conflict with professional interests must also be disclosed.
 
Significant Financial Relationship: Significant financial relationships are defined as anything of monetary value (within the past 12 months) including, but not limited to:
  • Salary or other payments for services (employment, Speaker's Bureau, Advisory Panel, Expert Witness, etc.)
  • Consulting fees or honoraria
  • Equity interests including stocks, stock options, or ownership interests (excluding diversified mutual funds)
  • Intellectual property rights including patents, copyrights, royalties from such rights
  • Research funding
  • Or other financial benefit
   [Note: Significant financial relationships extend to financial relationships of your family and/or business partner(s).]
 
Check the appropriate box(es) to designate your participation in AAO-HNS/F activities:
      Appointed Committee membership or elected leadership position
      Journal Editorial Board/Reviewer/Author
      Continuing Medical Education Planner/Teacher/Author/Administrator
 
Select one:
      I have nothing to disclose.
 
      I have the following relationships, commercial funding, or equity holdings to declare. (List in space provided)
 
 
Other relationship(s) that could cause private interests to conflict with professional interests:
 
 

Failure or refusal to disclose will result in disqualification to participate in AAO-HNS/F activities.
 
Submission
 

You will receive an email confirmation with an assigned tracking number for your reference. Applicants will be notified regarding committee appointments electronically in late June 2012. If you experience technical difficulties while completing this application please contact committees@entnet.org.