2017 Podium Presentation Submission Form Primary Author ContactThe Primary Author is the person who wrote the abstract and will present it.Name* First Last Degree Institution, City and State of the Primary AuthorEmail*Phone*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country ASPO Membership*Please identify your membership status with the American Society of Pediatric OtolaryngologyYes, I am a MemberNo, I am not a MemberAbstract InformationThe Program Committee has included the following list of preferred topics for 2017 submissions. Greater preference will be given to submissions which fall into the topics listed below, however additional submissions will be accepted. • Evaluation of Common Medical Conditions • Newly Published Quality Improvement Guidelines on Otitis Media with Effusion • Newly Published Treatment Guidelines of Thyroid Carcinoma • Standard Surgical Procedures With Potential Long-Term ComplicationsTitle of Abstract (150 character limit)*Abstract Instructions*Do not include the name of the author(s), institutions, pharmaceutical companies, or specific manufacturers on the abstract. Please insert your abstract (350 words maximum) below in black, single-spaced, 12 pt., Times New Roman font - (DO NOT include charts, graphs, or photographs.) Use initial caps only in title. Please split your abstract into the following four groupings in bold and all capitals: 1) INTRODUCTION 2) METHODS 3) RESULTS 4) DISCUSSION and CONCLUSION Abstract KeywordsPlease provide 3 to 6 keywords.Keyword 1*Keyword 2*Keyword 3*Keyword 4Keyword 5Keyword 6I approve of my abstract, if accepted, to be posted on the Frontiers In Pediatric Otolaryngology web site.*YesNoCo-Author InformationName, Degree, Phone Number and Email Address of all co-authors must appear on this form. Additional authors, submitted after abstract is accepted, will not be recognized. If abstract is accepted for presentation, the Primary Author is required to obtain Financial Disclosure for all of the co-authors at least 2-months prior to the meeting. The Financial Disclosure is available herePresentations will be eliminated from the program if any co-authors have not completed the disclosure form at least 2-months prior to the Meeting. Please only submit Financial Disclosure for the names submitted on this form. Only one disclosure per person is required.Co-Author 1 First Name Last Name Degree PhoneEmail Co-Author 2 First Name Last Name Degree PhoneEmail Co-Author 3 First Name Last Name Degree PhoneEmail Co-Author 4 First Name Last Name Degree PhoneEmail Co-Author 5 First Name Last Name Degree PhoneEmail Co-Author 6 First Name Last Name Degree PhoneEmail Mandatory Financial DisclosureFor your abstract to be considered, you MUST submit a Financial Disclosure Form. The Disclosure Form is available here. In accordance with the ACCME regulations, a disclosure form must be completed and uploaded into the field below. University of Colorado School of Medicine Disclosure Policy: The University of Colorado School of Medicine (UCSM) requires that a rigorous behavioral and educational performance needs assessment is the driver of the content and the educational method, ensuring that the scientific content is evidence-based. UCSM recognizes that to ensure transparency of financial relationships and eliminate commercial bias in CME activities, anyone who is in a position to control content of a CME activity (such as planners, faculty, authors and reviewers of CME) must disclose to OCME&PD a financial relationship with a commercial interest relevant to the proposed CME activity. The OCME&PD uses the mechanisms described below to identify and resolve all conflicts of interest prior to the CME activity taking place. If an individual who is in a position to control content of CME refuses to disclose relevant financial relationships to the OCME&PD, he/she will automatically be disqualified from any role in planning, management, presentation or evaluation of that CME activity. Commercial interests cannot take the role of a non-accredited provider in joint providership activities. Employees of commercial interests cannot be on the planning committee.Primary Author/Presenter Financial DisclosureDuplicate Submission: By checking this box I certify this has not been presented at another meeting in the last two (2) years.