To Whom It May Concern

The information I have provided on this application is in accordance with my consent to collect, use and provide such information and accurate and does not contain any false information to the best of my knowledge.

[CONSENT TO COLLECT AND USE]

<General Personal Information>
Purpose of Collection and Use:
I understand Korean Society of Otorhinolaryngology-Head and Neck Surgery (KSORL-HNS) requires certain information about me to evaluate my qualifications for enrollment as an international member and to provide the society's online contents if I become an international member.
I hereby confirm an accept to receive the information related to the KSORL-HNS which includes conference agenda and schedule via email delivery

Items to be collected and used:
I hereby agree that the items to be collected contains verification of the personal information such as the name, mobile phone number, degrees, date of birth, gender, specialty, subspecialty, home address and zip code, city of residence, country of residence, office address and zip code, home phone number, office phone number, e-mail address, fax number, information on graduate school (medical school, graduate school, etc), and information on undergraduate school (Internships, Residencies, Fellowships, etc).

Duration of Possession:
I understand and acknowledge; that upon completion of international membership evaluation, KSORL-HNS will immediately destroy the scanned copy (received through fax or email) of the consent form upon my request and that in the case such request is not made, the scanned copy (received through fax or email) will be kept as long as I am an active international member.

I, hereby submit this Consent Form.