Invited Faculty/Speakers/Chair/Co-Chairpersons & Moderators Disclosure Form

57th Annual World Congress-International College of Angiology

Invited Faculty, Speaker's Disclosure Statement and Conflict of Interest

As a participant in the 57th Annual World Congress, the International College of Angiology (ICA) requires that everyone who is in a position to control the content of an educational activity must complete, sign and return a disclosure statement upon the initiation of planning an educational activity. This disclosure statement must include all relevant financial relationships with any commercial interest within the past 12 months that could be perceived as a conflict of interest. Any individual who refuses to disclose relevant financial relationships will be disqualified from being planning committee member, a teacher or an author of medical educational content, and cannot have control of or responsibility for the development, management, presentation or evaluation of an educational activity.

It is the policy of the International College of Angiology to ensure balance, independence, objectivity, and scientific rigor in all educational activities. Anyone engaged in content development, planning or presentation MUST complete this form. Persons who fail to complete any of the REQUIRED FORMS BELOW may not participate in the CME activity.

The International College of Angiology (ICA) is required to identify all relevant financial relationships with any commercial interest; determine whether these relationships create a conflict of interest with the individual's control of content and resolve all conflicts before the educational activity occurs.

The ICA relies upon Program Directors, planners, scientific committee members, session chairpersons, co-chairpersons, moderators, invited faculty and speakers participating in its CME programs to provide educational information that is objective and free from bias. In this spirit, the ICA follows those guidelines as set forth by the ACCME Standards for Commercial Support, which requires all Program Directors, planners, scientific committee members, session chairpersons, co-chairpersons, moderators, invited faculty and speakers are expected to disclose the existence of any relevant financial interest or other relationship the faculty member (spouse or partner) or provider has with the manufacturer of any commercial product discussed in an educational presentation.
All are expected to disclose:
Any relevant financial relationship with the provider of commercial products or services discussed in their educational presentation or that have directly supported the CME activity through an educational grant to the sponsoring organization(s).
and
If the product he/she will be discussing is not labeled for the use under discussion or that the product is still investigational.

NOTE: The International College of Angiology utilizes the ACCME definition "relevant financial relationships" as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. ACCME considers relationships of the person involved in the CME to include financial relationships of a spouse or partner. All commercial relationships that create a conflict with the faculty’s control of content must be resolved before the educational activity occurs.
PLEASE COMPLETE ALL RELEVANT FORMS TO YOUR PARTICIPATION IN THIS CONGRESS
If you prefer, you can download the PDF version of the form below and submit it to:
Denise M. Rossignol, Executive Director
International College of Angiology
denisemrossignol@cs.com or denise.m.rossignol@intlcollegeofangiology.org