Disclosures for the 2022 Annual Meeting
Declaration of Speaker Financial Interests or Relationships
(Required only for first author and/or their spouse or partner)
The ISMRM is committed to…
- ensuring balance, independence, objectivity and scientific rigor in all Continuing Medical Education programs, and
- presenting CME activities that promote improvements or quality in healthcare and are independent of the control of commercial interests.
As part of this commitment, the ISMRM has implemented a process in which speakers, and everyone else who is in a position to control the content of an education activity, discloses all financial relationships with any commercial interest, to any extent within the last 12 months (click on links for definitions). In addition, should it be determined that a conflict of interest exists as a result of a financial relationship, this will need to be resolved prior to the activity. In order for us to do this, please provide the required information.
If you do not complete this form, whether or not you have relevant financial relationships, you will be disqualified from participating in the planning and implementation of this CME activity.
Affiliations and financial interests disclosed will be indicated in program and syllabus listings and in each talk. The ISMRM does not imply that such financial interests or relationships are inherently improper or that such interests or relationships would prevent the speaker from making a presentation. The intent is that any conflict should be identified, resolved and disclosed so that listeners may form their own judgments about the presentation in the light of full disclosure of the facts.
The declaration applies to any real or apparent financial interest or other relationship (i.e., grants, research support, consulting fee, royalty, honorarium for promotional speakers’ bureau, ownership interest, etc.) that the individual may have (or have had within the last 12 months) with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. This disclosure requirement extends to interests/financial relationships of spouses/partners. It does not apply to relationships with non-profit or governmental bodies, or non-health care related companies.
INSTRUCTIONS
First, check the “Participant Agreement” boxes below to acknowledge that you have read this form and agree to all its provisions.
Second, check either of the two “Declaration” boxes below to indicate that either…
- you do have relevant interests to disclose, or
- you do not have such interests to disclose.
Third, if you have checked the first “Declaration” box, then provide information on the types of interests/conflicts in the spaces provided. For each type of relationship there is a drop-down list showing possible company names. You can also indicate “Other”, in which case the name of the company or other information must be entered in the space provided.
If the type of relationship you disclose does not fall under one of the categories shown, please enter it in the “Other” section at the bottom of the form.
The ISMRM does NOT want to know how much you received. Please do not provide the amount.
PARTICIPANT AGREEMENT
Please check each box below to acknowledge that you have read this form and agreement, and that if your abstract is accepted you will satisfy all obligations and responsibilities of meeting presenters, including observance of the following ISMRM policies: