Society for Light Treatment and Biological Rhythms
Continuing Medical Education Policy on Full
Disclosure
The Accreditation Council for Continuing Education (ACCME) requires that the Society for Light Treatment and Biological Rhythms obtain disclosure of the existence of any significant financial interest or other relationship a presenter has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation.
The existence of such relationships does not
necessarily constitute a conflict of interest, but the prospective audience
must be informed of presenter's affiliation with a commercial sponsor by way of
an acknowledgment in the printed program or syllabus.
This policy is intended to openly identify any
potential conflict so that the audience in an educational activity is able to
form its own judgments about the presentation. A reasonable test to guide
decisions about what to disclose is whether any particular affiliation could
cause embarrassment to the individual or institution involved, or lead to
questions about the speaker's motives, if such affiliation(s) were made known
to the general public.
Each
participant must return a completed disclosure statement with the abstract
submission form, or the submission cannot be considered. Photocopies of the
Disclosure Statement may be used.
Please complete and return this
signed form with your Abstract Submission Form.
FAX: 415-751-2758 OR MAIL TO:
SLTBR, PO Box 591687
San Francisco, CA 94159-1687
______________________________________________________________________________
SLTBR ANNUAL MEETING
May 28-30, 2004
I have
read the SLTBR policy on full disclosure and declare:
_______
Neither I, nor any members of my immediate family, or any of my co-authors or
members of their families, have a significant financial interest in or
affiliation with any manufacturer or any commercial product discussed in
presentation(s) at this meeting.
_______ I
(or an immediate family member) or one or more of my co-authors or their
immediate family members have a significant financial interest in or
affiliation with the manufacturer of a commercial product discussed in my
presentation(s) at this meeting.
Name of
Manufacturer(s) and nature of relationship with each, e.g., stock or bond
holdings, research grants, employment, ownership or partnership, consulting
fees, other remuneration (i.e., honoraria, travel expenses):
Name of
manufacturer/Nature of relationship
________________________________________
____________________________________
________________________________________
____________________________________
________________________________________
____________________________________
________________________________________
____________________________________
Name of
presenter (please print) and signature of
presenter
________________________________________
____________________________________
Telephone
number _________________________ Date _______________________________
Email____________________________________