Resident Leadership Grant Application - Leadership Forum

2015 AAO-HNS/F Leadership Forum
March 14-16

Submission Deadline: Monday, February 2, 2015

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 2015 AAO-HNS/F Leadership Forum. 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, March 14 through its conclusion on Monday, March 16, 2015. 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. If awarded a grant, please select how you would prefer to receive it (select only one of the bolded options below):

Please email Bethany Clifton (bclifton@entnet.org) immediately after you apply for this Resident Leadership Grant to make certain we received your application.

URGENT: If your information is incorrect we will not be able to pull your information for the decision process. Make sure to double check your application before submitting it.