Society for Vascular Surgery
Email education@vascularsociety.org
Fax: 312-334-2320
CONFLICT OF INTEREST DISCLOSURE
It is the policy of the Society for Vascular Surgery to insure balance, independence, objectivity and scientific rigor in all its
individually sponsored CME activities. In accordance with ACCME guidelines and standards, all faculty participating in any CME
activities are expected to disclose to the audience prior to the beginning of the activity all relevant financial relationships with the (1)
name of the commercial interest(s) and (2) nature of the relationship with each commercial interest within the past 12 months.
Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property
rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified
mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management
position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory
committees or review panels, board membership, and other activities from which remuneration is received, or expected. ACCME
considers relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. The
intent of this disclosure is not to prevent a presenter with a relevant financial relationship from making a presentation; but rather to
provide the listeners with information on which they can make their own judgments. It remains for the audience to determine
whether the speaker's interests or relationships may influence the presentation. In addition, presenters must make a meaningful
disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices.
In accordance with ACCME requirements, failure to disclosure information in a timely manner will result in the disqualification from
this activity.
CME ACTIVITY & DATE:
Postgraduate Courses, June 15, 2011
Vascular Annual Meeting, June 16-18, 2011,
Chicago, IL
Please indicate your role in this activity:
Speaker
Moderator/Course Director
Author
Other_______________
I have no relevant financial relationships to disclose.
I, the undersigned (or an immediate family member), have a financial arrangement or affiliation with a corporate organization
offering financial support or grant monies; and/or a financial relationship with a manufacturer or a product as listed below:
NOTE: There is no need to disclose the actual financial value of any affiliation.
Nature of Relevant Financial Relationship
Name of Corporate Organization and Your or Family Member’s Role
Research Grants
Employment (Full- or Part-Time)
Honoraria
Speakers Bureau
Scientific Advisory Committee
Consulting Fees or Other Remuneration (Payment)
Stock Options or Bond Holdings
Other ____________________________________
I intend to reference unlabeled/unapproved uses of drugs or products in my presentation. Specify product by name for which
unlabeled use will be discussed:
I have read and agree to the Terms and Conditions listed on the following page.
Signature: ______________________________________ Print Name: ___________________________________________
Date: ______________________
TERMS AND CONDITIONS FOR FACULTY
REGARDING COMMERCIAL SUPPORT RULES
FACULTY/AUTHORS/PRESENTERS:

Disclosure: Speakers/authors must complete and submit the Disclosure Statement located on the front side
of this document prior to the presentation, and ensure that the Disclosure Statement is complete and truthful to
the best of the presenter’s knowledge. Faculty members are required to disclose any financial relationships
they may have with a manufacturer of any product or class of products they discuss in an educational activity.

Fair Balance: Speakers/authors are required to prepare fair and balanced presentations that are objective and
scientifically rigorous.

Commercial Supporter Influence: Faculty members are not permitted to receive any direct remuneration or
gifts from the commercial supporter(s) of this activity, nor should they be subject to direct input from a
commercial supporter regarding the content of their presentation.

Unlabeled and Unapproved Uses: Presentations that provide information in whole or in part related to nonFDA approved uses for drug products and/or devices must clearly acknowledge the unlabeled indications or
the investigational nature of their proposed uses for commercial products and/or devices must provide this
information to the Association.

Use of Generic versus Trade Names: Presenters should use scientific or generic names when referring to
products in their lectures or enduring materials. Should it be necessary to use a trade name, then the trade
names of all similar products or those within a class should be used.

Content Validation: Faculty members must present content that is based on evidence that is accepted within
the profession of medicine as adequate justification for their indications and contraindications in the care of
patients. All scientific research referred to, reported or used in CME in support or justification of a patient care
recommendation must conform to the generally accepted standards of experimental design, data collection
and analysis.

Copyright: Faculty members must obtain in writing all consents, authorizations, approvals, and releases from
Journal/Textbook publishers in order to include these articles in the program syllabus. SVS cannot reprint
articles for which written copyright permission is not given.
2