2024 NWUS Abstract Submission Form

Policy on Full Disclosure & Content

Financial Relationships

All educators must disclose relevant financial relationships with any commercial interest for themselves or their spouse. This includes any financial amount or affiliation (speakers Bureau, consultant) during the last 12 months that creates a conflict of interest (i.e. relationship with manufacturer of products discussed or commercial services discussed). Having an affiliation with a commercial interest is not bad but must be disclosed to all attendees of the course through verbal statements or written on the brochures, syllabi or hand outs. This standard is primarily here to not prevent speakers from speaking but so the participants have full disclosure on the facts, so they can form their own judgment on the content.

Commercial Interest Definition

A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME does not consider providers of clinical service directly to patients to be commercial interests - unless the provider of clinical service is owned, or controlled by, an ACCME-defined commercial interest.

Unlabeled products

You must disclose if a product or device you discuss is off-label, experimental, or investigational.

Non-Bias Content

Any educational material (slides, handouts etc) may not have any advertisements, name brands, or product group messages.

The presentation should have a balanced view of therapeutic options. Generic names are useful, and if there are name brands try not to have all of them from the same company.

Name*

PrefixFirstMiddleLastSuffix

Email*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Disclosure of Financial Relationship*

I or my spouse DO NOT have a relevant financial interest/affiliation with the manufacturer(s) of commercial products and/or providers of services that will be in this educational activity.I or my spouse DO have a relevant financial interest/affiliation with the manufacturer(s) of commercial products and/or providers of services that will be in this educational activity.

Please list corporate organization and your relationship with them. (Employment, consultant fees, stocks and bonds, research grants and any other financial relationship in the last 12 months.)

Disclosure of off-label products*

I WILL NOT be discussing information that is related to an off-label or investigational use of any therapy, product, or device in this activity.I WILL be discussing information that is related to an off-label or investigational use of any therapy, product, or device in this activity.

Products/Devices

I have read the disclosure policy. I understand if I have relevant financial interests, it must be disclosed to participants at the educational activity before your presentation.*

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Date*

Date