Endorsement Application

Educational Meeting Title:

Dates:

Chairman/Co-Chairmen and Board Certification[s]:

Organization Seeking Endorsement:

Address:

Primary Contact Person:

Primary Contact Email Address:

Website:

Please provide a short abstract of the planned meeting:

List the meeting’s goals and objectives:

List the faculty (If not plastic surgeons, facial plastic surgeons, or otorhinolaryngology surgeons, list specialty):

To what other organizations have you applied for endorsement?

Has your application for endorsement been accepted?YesNo
If yes, which organizations:

To what medical specialties will this educational activity be marketed:

The undersigned, in consideration of being designated Chairman or Co-Chairman of the aforementioned meeting, acknowledges that:

• he/she has read, understands, and agrees to abide by each of the Policies for Endorsement;
• an endorsement fee of $500 USD will be paid to the Rhinoplasty Society 60 days before the meeting;
• copies of all promotional materials will be sent to the Rhinoplasty Society.

Signed:

CLICK BELOW TO SEND TO THE TRS EXECUTIVE OFFICE

before proceeding. Then proceed to payment below: