The completion of this entire form is required for ALL potential peer reviewers to submit an application.

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PLEASE READ BEFORE PROCEEDING

At this year's event, GLMA will be partnering with accreditation entities to provide joint accreditation for continuing education for the healthcare team. All CME/CE/CEU providers are required to identify and mitigate financial relationships among those responsible for accredited CME/CE/CEU activities. We fully comply with all Standards and Criteria in the development of our CME/CE/CEU activities.

As potential peer reviewers, 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 CME/CE/CEU.

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 Peer Reviewer

As a prospective peer reviewer, 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/CEU 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.

Note that ACCME standards require owners and employees of ineligible companies be excluded from participating as planners, reviewers or faculty. For information about limited exceptions to this exclusion, please see the ACCME's website.

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There are three more pages to complete.

To participate as a peer reviewer at GLMA's 44th 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 educational materials I review (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 is HIPAA compliant (e.g., I have only used de-identified patient information).

There are two more pages to complete.

This section requires the submission of peer reviewer information, including your bio and CV.

Please format all files as "Peer Reviewer Last Name_Peer Reviewer First Name_FileType_2026" (for example "Doe_Jax_Headshot_2026" or "Doe_Jax_CV_2026").

Several guidelines:

• Applications with missing documents will NOT be evaluated.
• Improperly labeled documents may be considered missing, which could result in a application NOT being evaluated.

Please contact annualconference@glma.org if you have any questions.

There is still ONE more page to complete. 

Answers to these questions will help us understand who may be under-represented or missing from the pool of peer reviewers 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 our peer reviewers. For more information, please email annualconference@glma.org.

 

You're ready to submit your Peer Reviewer Application Form for GLMA's 44th Annual Conference on LGBTQ+ Health. Thank you!