Multidisciplinary Teams of Distinction Application

Program Description:

Institutions may be eligible if they have a ‘team’ of four Active or International NASBS members as follows:
- one otolaryngologist, rhinologist, head and neck surgeon, or otologist /neuro-otologist;
- one neurosurgeon
- two non-core members from specialties such as ophthalmology, radiology, radiation oncology, oral maxillo-facial surgery, surgical oncology (Board Certified in General Surgery), plastic/reconstructive surgery, endocrinology, pathology, neurology, or medical oncology
The two non-core members must be from different specialties (example: one plastic surgeon and one pathologist)
Candidate and Affiliate members are not eligible to be counted towards the team of four
An institution could have multiple teams if there is a significant rationale (such as a University with multiple locations), but no individual team member may be counted towards multiple teams.
All team members must be in ‘good standing’ (dues paid in full).
All physicians joining NASBS as part of the MTD would still need to meet all requirements for membership and follow the normal new member application process and review time-table.
If an institution has a team member with a pending membership application, they may submit an application that includes the pending member. The MTD application would then be approved by the Membership Committee and the institution posted to the MTD listing after the membership has been approved. After approval, the team will be provided with materials (Logo and approved language) for use in announcements or postings about the designation. Any alternate language must be approved in writing by NASBS prior to use.
If a team member leaves an institution or discontinues Active or International membership in the Society during the year, the institution should notify NASBS. The posting may remain active until reviewed by staff for continued eligibility (upon notification), and deemed no longer eligible.
If an Institution’s MTD application contains NASBS Candidate members who will be upgrading to Active or International membership status during the year, the application will be considered pending until the Candidate members have upgraded their membership and paid dues if applicable.

Institution Name*
Please indicate how you would like your institution name to appear on the Multidisciplinary Teams of Distinction:
Main Contact Person*
Please provide the name and contact details for the point of contact for your NASBS Team.
First Name Last Name Title Email Address Phone Number
Team Member from Otolaryngology, Rhinology, Head and Neck Surgery, or Otology/Neuro-otolgy*
Please provide the information below
First Name Last Name Title Specialty Email Address NASBS Member Type
Team Member from Neurosurgery*
Please provide the information below
First Name Last Name Title Specialty Email Address NASBS Member Type
Team Member (1 of 2) from a Non-core specialty such as Ophthalmology, Radiology, Radiation Oncology, Oral Maxillo-facial Surgery, Plastic/Reconstructive Surgery, Endocrinology, Pathology, Neurology, or Medical Oncology*
Please provide the information below
First Name Last Name Title Specialty Email Address NASBS Member Type
Team Member (2 of 2) from a Non-core specialty such as Ophthalmology, Radiology, Radiation Oncology, Oral Maxillo-facial Surgery, Plastic/Reconstructive Surgery, Endocrinology, Pathology, Neurology, or Medical Oncology*
Please provide the information below
First Name Last Name Title Specialty Email Address NASBS Member Type
Phone
This field is for validation purposes and should be left unchanged.