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* 1. Proposal Title

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* 2. Submission Addresses

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* 3. Specialty Area – Proposals must be submitted in one of the following subject areas that best describes your presentation:

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* 4. PROGRAM DESCRIPTION Provide a concise description that will explain the focus and significance of your proposed session. You should provide a description of the relevance of this program to the practice of otolaryngology and the purpose (goals) of the presentation. If selected, your description will be published online to help attendees choose among sessions.

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* 5. OUTCOME OBJECTIVES– Objectives focus participants’ attention on the expected behavioral outcomes from the presentation. You should state clearly what attendees should be able to practice upon completion of the session. Begin each statement with a verb (i.e., analyze, compare, demonstrate, examine, explain, implement, interpret, recognize, etc.). If selected, your objectives will be published online to help attendees choose among sessions.

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* 6. BACKGROUND STATEMENT – provide a short statement explaining why this topic should be addressed at the Pan American Congress. What general clinical or patient need led you to submit this abstract? The background statement is an opportunity to provide additional information to the Program Committee on the clinical relevance or timeliness of your presentation. The text will not be published and is for the use of the selection committee. Review and click Submit.

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* 7. Submitter Contact Information

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* 8. Moderator Contact Information

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* 9. Moderator Disclosure: The Pan-American Congress supports fair and unbiased participation of our volunteers in activities. Any actual or potential conflicts of interest must be identified and managed. All direct financial and intellectual relationships with a company that directly impact and/or might conflict with Congress activities must be disclosed, or you must disclose that you have no direct financial relationships. Other relationships that could cause private interests to conflict with professional interests must also be identified. This policy is intended to openly identify any potential conflict so that any potential bias may be identified and the risk thereof mitigated. Failure or refusal to complete the disclosure form or disclose all relevant relationships will result in disqualification to participate in the Pan-American Congress.

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* 10. Presenter #1 Contact Information

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* 11. Presenter #1 Disclosure: The Pan-American Congress supports fair and unbiased participation of our volunteers in activities. Any actual or potential conflicts of interest must be identified and managed. All direct financial and intellectual relationships with a company that directly impact and/or might conflict with Congress activities must be disclosed, or you must disclose that you have no direct financial relationships. Other relationships that could cause private interests to conflict with professional interests must also be identified. This policy is intended to openly identify any potential conflict so that any potential bias may be identified and the risk thereof mitigated. Failure or refusal to complete the disclosure form or disclose all relevant relationships will result in disqualification to participate in the Pan-American Congress.

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* 12. Presenter #2 Contact Information

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* 13. Presenter #2 Disclosure: The Pan-American Congress supports fair and unbiased participation of our volunteers in activities. Any actual or potential conflicts of interest must be identified and managed. All direct financial and intellectual relationships with a company that directly impact and/or might conflict with Congress activities must be disclosed, or you must disclose that you have no direct financial relationships. Other relationships that could cause private interests to conflict with professional interests must also be identified. This policy is intended to openly identify any potential conflict so that any potential bias may be identified and the risk thereof mitigated. Failure or refusal to complete the disclosure form or disclose all relevant relationships will result in disqualification to participate in the Pan-American Congress.

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* 14. Presenter #3 Contact Information

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* 15. Presenter #3 Disclosure: The Pan-American Congress supports fair and unbiased participation of our volunteers in activities. Any actual or potential conflicts of interest must be identified and managed. All direct financial and intellectual relationships with a company that directly impact and/or might conflict with Congress activities must be disclosed, or you must disclose that you have no direct financial relationships. Other relationships that could cause private interests to conflict with professional interests must also be identified. This policy is intended to openly identify any potential conflict so that any potential bias may be identified and the risk thereof mitigated. Failure or refusal to complete the disclosure form or disclose all relevant relationships will result in disqualification to participate in the Pan-American Congress.

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* 16. Presenter #4 Contact Information

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* 17. Presenter #4 Disclosure: The Pan-American Congress supports fair and unbiased participation of our volunteers in activities. Any actual or potential conflicts of interest must be identified and managed. All direct financial and intellectual relationships with a company that directly impact and/or might conflict with Congress activities must be disclosed, or you must disclose that you have no direct financial relationships. Other relationships that could cause private interests to conflict with professional interests must also be identified. This policy is intended to openly identify any potential conflict so that any potential bias may be identified and the risk thereof mitigated. Failure or refusal to complete the disclosure form or disclose all relevant relationships will result in disqualification to participate in the Pan-American Congress.

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