American College of Surgeons
The Voice Foundation's
46th Annual Symposium:
Care of the Professional Voice
May 31 - June 4, 2017 * Philadelphia, PA USA
Speaker Disclosure of Relevant Financial Relationships
In accordance with ACCME regulations, the American College of Surgeons, as the accredited provider of this activity, must ensure that anyone who is in a position to control the content of the education activity has disclosed to us all relevant financial relationships with any commercial interest (see below for definitions) as it pertains to the content of the presentation. Should it be determined that a conflict of interest exists as a result of a financial relationship you may have, you will be contacted and methods to resolve the conflict will be discussed with you. In addition, all affirmative disclosures must be revealed by a slide at the beginning of the presentation. Failure or refusal to disclose or the inability to resolve the identified conflict will result in the withdrawal of the invitation to participate.
The presenting author is required to fill out this form.
If you answered yes to the previous question, you DO have relevant financial relationships with commercial interests that pertain to the content of your presentation:
• List the names of proprietary entities producing health care goods or services, with the exemption of non-profit or government organizations and non-health care related companies with which you or your spouse/partner have, or have had, a relevant financial relationship within the past 12 months. For this purpose we consider the relevant financial relationships of your spouse or partner that you are aware of to be yours.
• Explain what you or your spouse/partner received (i.e. salary, honorarium etc).
• Specify your role.
What was received: Salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g. stocks, stock options, etc), or other financial benefit.
