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□ Review article     □ Original article     □ Case report

Title: ___________________________________________________________________________

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Form 1. Prior publication certification

1. This manuscript contains original material. Neither the article nor any part of its essential substance, tables or figures have been or will be published elsewhere prior to appearing in the J Rhinol.

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2. Some of the material in this paper has been, or is being published elsewhere. Details are supplied in the appended letter.

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Form 2. Assignment of any and all copyright

In consideration of the J Rhinol taking action in reviewing and editing my (our) submission, the author(s) undersigned hereby transfer, assign and otherwise convey all copyright ownership to the J Rhinol in the event that such work is published by the J Rhinol. In addition to publication of my (our) article in conventional printed form, my (our) assignment of copyright also signifies my (our) agreement to its publication and/or storage electronically. The publisher may also arrange to include my article in electronic document-delivery services and databases.

Must be signed by all Authors:

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Form 3. Conflict of interest disclosure statement by an author of a manuscript submitted to the Journal of Rhinology

I, (We) _____________________, have submitted for publication in the J Rhinol
a manuscript entitled:

_____________________________________________________________________________________________
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I, (We) hereby certify, that to the best of our knowledge (Please circle one) :

• 1. No financial support or benefits have been received by me or any co-author, by any member of my (our) immediate family or any individual or entity with whom or with which I (we) have a significant relationship from any commercial source that is related directly or indirectly to the scientific work reported in the article except as described below.
• 2. I (we) understand an example of such financial interest would comprise a stock interest in any business entity, which is included in the subject matter of the manuscript or which sells a product relating to the subject matter of the manuscript: Exceptions:
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• If any commercial support or special financial interests are described above, I (we) understand that the Journal staff will make every effort to keep such information confidential during the editorial review process. I (we) also understand that if the manuscript is accepted, you will discuss with me (us) the manner to which such information, is to be communicated to the reader. I (we) hereby grant permission for any such information, or an appropriate summary to be published in the Journal with the manuscript if the manuscript is accepted for publication. The corresponding author has an obligation to making sure any and all co-authors sign and date in this form.
• Name of the Corresponding Author: ______________________________________________________________
• Signature:_______________________________________ Date:________________________________________