Sample Disclosure Slide
for Presenters
Presentation Title
Presenter’s Name
My disclosure along with my co-authors is listed in the
disclosure index on the DVD-Rom of the Transactions
of the ORS 2012 Annual Meeting.
I have no potential conflicts with this presentation.
Presentation Title
Presenter’s Name
My disclosure along with my co-authors is listed in the
disclosure index on the DVD-Rom of the Transactions
of the ORS 2012 Annual Meeting.
I have a potential conflict with this presentation due to…
One or more of the authors of the next presentation
have identified the following potential conflicts of
interest.
1.
2.
3.
4.
5.
Royalties
Speakers Bureau/paid presentations
Employee, Paid Consultant, or Unpaid Consultant
Financial/Material Support
Stock or stock options
One or more of the authors of the next presentation
have identified the following potential conflicts of
interest.
6. Research or institutional support from
company/supplier
7. Research or institutional support through department,
division, or practice
8. Financial/material support from medical or
orthopaedic publisher
9. Research or institutional support from medical and/or
orthopaedic publisher
10. Research or institutional support from medical
and/or orthopaedic publisher through
department, division or practice.
Title of Talk
Jane Doe
My disclosure along with my co-authors is listed in the
disclosure index on the DVD-Rom of the Transactions
of the ORS 2012 Annual Meeting.
I have a potential conflict with this presentation –
Royalties received from ABC Company; Research
support received from XYZ Company; stock in 123
Company, Inc.
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Sample Disclosure Slide for Presenters Presentation Title