Resident Leadership Grant Application - Leadership Forum

AAO-HNS/F 2017 Leadership Forum & BOG Spring Meeting
March 10-13

Submission Deadline: Friday, February 10, 2017

For U.S. and Canadian Residents only

 

Visit http://www.entnet.org/content/aao-hnsf-leadership-forum for information on registration and housing.

I, the undersigned, hereby apply for a Resident Leadership Grant for the AAO-HNS/F 2017 Leadership Forum & BOG Spring Meeting. If chosen, I understand and agree to accept the terms of an AAO-HNS/F Leadership Grant. I understand that I am responsible for attending the Leadership Forum from Saturday morning, March 11 through Sunday afternoon, March 12, 2017. If I do not comply with these terms, I will be held responsible for repaying the $350 grant to the AAO-HNS. Without a valid reason, non-compliance will preclude my training program from receiving travel grants in the future. I understand this information will be tracked through my membership record.

Receipt of this leadership grant may have some tax implications for you. Therefore, it is recommended that you contact your tax advisor to determine your circumstance before accepting the grant.

Please email Richard Carson, SRF staff liaison (rcarson@entnet.org) immediately after you apply for this Resident Leadership Grant to confirm receipt of your application.

All applicants will be notified of their outcome no later than February 22. If you receive an RLG, you will be contacted by Richard requesting your banking information (9-digit routing number & bank institution number) so an automatic deposit can be made to your account.