The completion of this entire form is required for ALL potential presenters to complete prior to finalizing the abstract application.

Failure to submit these forms with your abstract application will disqualify your application. A completed presenter form for EACH listed presenter must be submitted.

This form contains multiple pages. You have not completed the form until you click the "Click here to submit" button on the third page.

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PLEASE READ BEFORE PROCEEDING

GLMA is Accredited by the Accreditation Council for Continuing Medical Education (ACCME) and several other bodies to provide continuing education for the healthcare team. All CE providers are required to identify and mitigate financial relationships among those responsible for accredited CE activities. We fully comply with all Standards and Criteria in the development of our CE activities.

Even if you indicated that your abstract will not be consider for CE credit, you must complete this Presenter Form in its entirety.

As potential presenters, please identify ALL relationships you have with any Ineligible Companies in which you benefit by receiving a consulting fee, honoraria, salary, royalty, intellectual property rights, ownership interest or other financial benefit in any amount within the past 24 months. Individuals who refuse to provide this information will be disqualified from involvement in the planning and implementation of accredited CE.

An Ineligible Company is any company whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Providers of clinical services directly to patients are not considered to be Ineligible Companies.

Examples of Ineligible Companies include:

• Advertising, marketing or communication firms whose clients are Ineligible Companies.
• Bio-Medical startups that have begun a governmental regulatory approval
• Compounding pharmacies that manufacture proprietary compounds
• Device manufacturers or distributors
• Diagnostic labs that sell proprietary products
• Growers, distributors, manufacturers or sellers of medical foods and dietary supplements
• Manufacturers of health-related wearable products
• Pharmaceutical companies or distributors
• Pharmacy benefit managers
• Reagent manufacturers or sellers

Role: Prospective Presenters

As a prospective presenter, we would like to ask for your help in ensuring that accredited continuing education serves the needs of patients and the public, is based on valid content, and is free from commercial influence.

It is the policy of GLMA to ensure balance, independence and objectivity in all CME/CE activities. The ACCME Standards for Integrity and Independence require that we disqualify individuals who refuse to provide this information from involvement in the planning and implementation of accredited continuing education.

If you indicate a financial relationship that is determined as relevant to the content, you will be contacted to determine whether the relationship can be mitigated.

Thank you for your diligence and assistance. If you have questions, please contact us at annualconference@glma.org.

Instructions for Listing Financial Relationships

Please disclose all financial relationships that you have had in the past 24 months with ineligible companies (see definition below).

There is no minimum financial threshold; we ask that you disclose all financial relationships, regardless of the amount, with ineligible companies. You should disclose all financial relationships regardless of the potential relevance of each relationship to the education.

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To participate as a presenter at GLMA's 43rd Annual Conference on LGBTQ+ Health, I attest that:

• I agree that the education I am involved in will be fair and balanced, and that any clinical content will support safe, effective patient care.
• If I am discussing any product use that is off-label or investigational, I will disclose within the education that the use or indication is not currently approved by the FDA.
• I agree that the content I am involved in planning, developing, or implementing for an accredited CE activity will promote quality or improvements in healthcare and will not promote a specific proprietary business interest of an Ineligible Company.
• I agree that all recommendations for patient care will be based on current science, evidence, and clinical reasoning, while giving a fair and balanced view of diagnostic and therapeutic options.
• I agree that all scientific research referred to, reported, or used in support or justification of a patient care recommendation must confirm to the generally accepted standards of experimental design, data collection, analysis, and interpretation.
• If I am discussing specific healthcare products or services, I will not use trade/brand names of healthcare products or services.
• I agree that my educational materials (eg, PPT, handouts, monograph, etc.) will NOT contain any corporate or product logos, trade names, or product group messages for an Ineligible Company.
• I agree not to receive any direct remuneration or gifts from any Ineligible Company related to the accredited CE activity, nor will I allow any guidance or input from any Ineligible Company regarding activity. content.
• My contribution and presentation is HIPAA compliant (e.g., I have only used de-identified patient information).

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Recording of Presentations

As part of its continuing education efforts, GLMA occasionally records educational programs offered during its Annual Conference and makes those audio and video recordings, and/or edited transcriptions thereof, available to conference registrants, GLMA members, and other professionals interested in the topics being covered. We therefore request your permission to record, edit, transcribe, duplicate and perform your presentation delivered at GLMA's 43rd Annual Conference on LGBTQ+ Health, in any and all media now existing or hereafter developed, throughout the world.

You also grant GLMA the right to use your name, voice, photographs, videos and biography, in connection with the presentation and other materials. You further acknowledge and agree that GLMA is the absolute owner of any and all audio and video recordings, and/or edited transcriptions thereof, and photographs of your presentation at the Annual Conference.

License to Use Presentation Materials

In addition, you agree to grant GLMA a non-exclusive, royalty-free license to use, copy, modify, display, perform and distribute the content of your presentation and all associated materials in various media forms, including but not limited to hardcopy printouts, audiotape, videotape, CD-ROM, DVD, online and MP3. The licensed materials, including PDFs of slide presentations, may also be included shared with conference registrants and others for electronic download. GLMA reserves the right to share presentation materials with conference attendees, and other health professionals. Your consent does not prohibit you from using your material in any way in the future, nor does it give GLMA ownership of the material.

Copyright Release and Indemnification

You represent that (a) the presentation and all associated materials do not infringe or otherwise violate any third party’s copyright, trademark, trade secret or other intellectual property rights and (b) that you are the owner of all rights in the presentation and associated materials or have obtained appropriate written consent from the owner of any copyright or other intellectual property rights in the presentation and/or associated materials. You agree to indemnify, defend and hold harmless GLMA from any and all claims arising from or related to any infringement or related claims associated with GLMA’s use or other exploitation of the presentation and/or associated materials.

If you would like to discuss the Presenter Release Agreement further, please contact annualconference@glma.org.

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This section requires the submission of presenter information, including your bio, headshot, and CV.

Please format all files as "Presenter Last Name_Presenter First Name_FileType_2025" (for example "Doe_Jax_Headshot_2025" or "Doe_Jax_CV_2025").

Several guidelines:

• Proposals with missing documents will NOT be evaluated.
• Improperly labeled documents may be considered missing, which could result in a proposal NOT being evaluated.
• If you are submitting multiple abstract proposals, you MUST submit all supporting documents each time.
  
  Please contact annualconference@glma.org if you have any questions.

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Answers to these questions will help us understand who may be under-represented or missing from the pool of abstract submissions and the GLMA conference program. Please check all boxes that apply to you.

We will use this data to inform our outreach strategies and our efforts to deliver a balanced, broadly inclusive conference. While responses are required, there is a "prefer not to say" option for each question.

Answers to these questions are viewable only by GLMA's Education Committee, staff, and peer reviewers.

For more information, please email annualconference@glma.org.

 

You're ready to submit your Presenter Form for GLMA's 43rd Annual Conference on LGBTQ Health. Thank you!