ALBERTA SOCIETY OF OTOLARYNGOLOGY - HEAD & NECK SURGERY

ANNUAL MEETING & RESIDENT RESEARCH COMPETITION 2018

CALL FOR PAPERS

The Alberta Society of Otolaryngology would like to welcome applicants of all Otolaryngology Programs in Canada to present at our Annual Meeting at the Chateau Lake Louise, February 16-18, 2018. All accepted presenters will receive a travel bursary of $500 and a chance to win one of two prizes of $500 for Best Research and Best Presentation at the competition.

Please complete this abstract submission form, save it with a new name (use “Save As…”) and return it to:

Dr. Michael Deutschmann, Scientific Committee Chair at email: .

Training Program (University):

Paper Title:

Authors:

Speaker Name:

Telephone:

Email:

The email address indicated above will be the preferred method of communication.

In submitting this application, you and your supervisor acknowledge that acceptance of the abstract constitutes presenting at the Annual Meeting of the Alberta Society of Otolaryngology. Acceptance of your presentation will NOT preclude your submission of your paper for publication as the Alberta Society of Otolaryngology does not have a publication.

Name of Candidate:

Signature of Candidate:


ABSTRACT

Abstract must be 150 words or 15 lines. Please submit a structured abstract.

(Objectives, Methods, Results, and Conclusions).

LEARNING OBJECTIVES

It is the policy of the Alberta Society of Otolaryngology to ensure objectivity and scientific rigor in our continuing education. In accordance with the Royal College of Physicians and Surgeons of Canada guidelines for the Accreditation of Providers of Continuing Professional Development, individuals participating in such programs are expected to disclose to the program audience any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of the program. This pertains to relationships with pharmaceutical companies, biomedical device manufactures or other corporations whose products or services are related to the subject matter of the presentation topic.

Name of Speaker:

Presentation Title:

I will discuss an unapproved/investigative use of a commercial product/device.

I will NOT discuss an unapproved/investigative use of a commercial product/device.

I have made a presentation on behalf of a pharmaceutical company in the last 2 years OR received financial compensation. Please list the companies (Third party payment excluded):

I have/had a financial interest/arrangement/affiliation with one or more organization(s)

Affiliation/Financial Interest Name of Organization(s)

Grant/Research Support

Consultant

Other Financial or Material Support

I do not have/or had any financial interest/arrangement or affiliation with one or more organizations that could be perceived as real or apparent conflict or interest in the context of the subject of this presentation.

·  At the start of your presentation please disclose to the audience any real or apparent conflict(s) of interest that may have a direct bearing on the subject matter of the presentation.

·  During your presentation, please ensure that any copyrighted material that is presented is acknowledged as such and that its original source is credited.

·  During your presentation, please ensure use of generic names of pharmaceuticals.

Name of Candidate:

Signature of Candidate: