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Resident Leadership Grant Application - Leadership Forum

AAO-HNS/F 2018 Leadership Forum & BOG Spring Meeting
March 9-12

Submission Deadline: Monday, February 10, 2018

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 2018 Leadership Forum & BOG Spring Meeting. If chosen, I understand and agree to accept the terms of an AAO-HNS/F RLG. I understand that I am responsible for attending the Leadership Forum from Saturday morning, March 10 through Sunday afternoon, March 11, 2018. 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.

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 26. If you receive an RLG, you will be contacted by Richard requesting your banking information (9-digit routing number & bank institution number) so that an automatic deposit can be made to your account. Receipt of this leadership grant may have some tax implications for you. Therefore, you will also be required to complete an IRS W-9 form to finalize distribution of your RLG.