DISCLOSURE STATEMENT FOR ANESTHESIA & ANALGESIA
Editor-in-Chief Applicants
The International Association of Research in Anesthesiology (IARS) asks that any applicant for the
position of Editor-in-Chief, Anesthesia & Analgesia, disclose all relationships (financial and other
interests) in the spirit of total transparency. Generally, a conflict of interest could be said to exist when
individuals have material interests that could influence or could be perceived as influencing their
decisions or actions on behalf of the IARS.
NAME:
1.
Leadership Role in Other Organizations: Do you serve in a leadership capacity (e.g., board
member, committee members, advisor) for any other association, society, or foundation?
No
Yes
(If yes, please list.)
2. Relationship with Industry: Do you or any immediate family members have any financial
relationships with industry (pharmaceutical companies, equipment manufacturers, etc.),
including, but not limited to, salary or other payments for services (e.g., board membership,
consulting fees, honoraria, expert testimony, research grants, speakers bureaus, travel expenses
covered or reimbursed); and intellectual property rights (e.g., patents planned, pending or
issued, copyrights and royalties from such rights)?
No
Yes
(If yes, please list all relationships, including those that were present during the
36 months prior to this application.)
3. Nonfinancial Relationships: Do you have any relevant non-financial relationships, conditions
and/or circumstances that may raise a conflict of interest or reflect poorly on Anesthesia &
Analgesia or the IARS?
No
Yes
(If yes, please explain.)
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