Abstract Submission - Invited Speaker

Deadline for submission: December 15, 2011

Speakers who are presenting at pharmaceutical sponsored mini symposiums and pharmaceutical company speakers presenting on Emerging Novel Therapeutic Targets, please submit your abstract here pharmaceutical submission

All other speakers please complete this form.
You will not be able to save this form for future editing.
For this reason, it is advisable to create the abstract in word or another program, and then paste it into the online abstract form.

Special Characters:
If your name or abstract requires the use of a special character, you may use the page linked here > to copy and paste the character where it is needed in your submission.

Principal Presenter Information
* Required Field      
Salutation *    
First Name * Family Name *
Mailing Address * City *
State / Province Country *
    Postal Code*
Home Phone
area code, prefix, number 		Preferred Email *
Business Phone
area code, prefix, number		 Institution *
Institution Name
Authors
Authors should be listed in the proper order. Full name(s) of the institution(s) is required.
Author 1 First Initial(s)    Last Name
 
Institution Name
city,state,country
 
Author 2 First Initial(s)    Last Name
 
Institution Name
city,state,country
 
Author 3 First Initial(s)    Last Name
 
Institution Name
city,state,country
 
Author 4 First Initial(s)    Last Name
 
Institution Name
city,state,country
 
Author 5 First Initial(s)    Last Name
 
Institution Name
city,state,country
 
Author 6 First Initial(s)    Last Name
 
Institution Name
city,state,country
 
Author 7 First Initial(s)    Last Name
 
Institution Name
city,state,country
 
Author 8 First Initial(s)   Last Name
 
Institution Name
city,state,country
 
Author 9 First Initial(s)    Last Name
 
Institution Name
city,state,country
 
Author 10 First Initial(s)    Last Name
 
Institution Name
city,state,country
 
Author 11 First Initial(s) Last Name
 
Institution Name
city,state,country
 
Author 12 First Initial(s) Last Name
 
Institution Name
city,state,country
 
Author 13 First Initial(s) Last Name
 
Institution Name
city,state,country
 
Author 14 First Initial(s) Last Name
 
Institution Name
city,state,country
 
Author 15 First Initial(s) Last Name
 
Institution Name
city,state,country
Category & Title
  Category - Invited Speaker
  Title of Presentation
   
Abstract

If your abstract requires the use of a special character, you may use the page linked here > to copy and paste the character where it is needed in your submission.


(Maximum characters: 2200)
Characters left.

 
Please provide three keywords (separate by commas)
 
Conflict of Interest

CONFLICT OF INTEREST DISCLOSURE POLICY. Submissions must include completed Conflict of Interest (COI) forms from all co-authors. The submitting author's COI form must be completed as part of this online abstract submission. The form for all other co-authors is available for download at: http://www.siumed.edu/cme/alzheimer/pdf/COIDisclosure.pdf The submitting author must also collect completed COI forms from all co-authors and submit them within 2 weeks of this abstract submission. Acceptance of your abstract submission is contingent upon receipt of a completed COI form from ALL authors/presenters. Directions for submitting the additional COI forms will be included in an email you will receive once your abstract submission is completed. Please do not submit the abstract more than once.
* Please choose one:    
  I am the only author    
  I will be providing COI for Co-Authors  
     
Faculty or Planning Role:  
Scientific Advisory Committee    Speaker    Co-Author    Moderator     Other
The purpose of this form is to identify and resolve all potential conflicts of interests that arise from financial relationships with any commercial or proprietary entity that produces healthcare-related products and/or services relevant to the content you are planning, developing, or presenting for this activity.  This includes any financial relationships within the last twelve months, as well as known financial relationships of your spouse or partner.
Please Choose One:      
  I have no financial relationship with a commercial entity producing health-care related products and/or services.
  The commercial entities with which I have relationships do not produce health-care related products or services relevant to the content I am planning, developing or presenting for this activity.
  I disclose the following financial relationships with commercial entities that produce healthcare-related products or services relevant to the content I am planning, developing or presenting:
   
Company
Type of Relationship*
Content Area (if applicable)
  1.
  2.
  3.
  4.
  5.
  6.
  7.
    *Type of relationship may include:  full-time or part-time employee, independent contractor, consultant, research or other grand recipient, paid speaker or teacher, membership on advisory committees or review panels, ownership interest (product royalty/licensing fees, owning stocks, shares, etc) or any other financial relationship.
ATTESTATIONS

Please indicate your understanding of and willingness to comply with each statement below.  If you have any questions regarding your ability to comply, please contact the activity coordinator as soon as possible.
 
Agree
Disagree
 
    I have disclosed to SIU School of Medicine all relevant financial relationships, and I will disclose this information to learners verbally (for live activities) and in print.
    The content and/or presentation of the information with which I am involved will promote quality or improvements in healthcare and will not promote a specific proprietary business interest of a commercial interest.  Content for this activity, including any presentation of therapeutic options, will be well-balanced, evidence-based and unbiased.
    I have not and will not accept any honoraria, additional payments or reimbursements beyond that which has been agreed upon directly with the SIU School of Medicine.
    I understand that SIU School of Medicine may need to review my presentation and/or content prior to the activity, and I will provide educational content and resources in advance as requested.
         
  Agree Disagree
N/A
  
  If I am presenting at a live event, I understand that a CME monitor will be attending the event to ensure that my presentation is educational, and not promotional, in nature.
  If I am providing recommendations involving clinical medicine, they will be 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 of justification of a patient care recommendation will conform to the generally accepted standards of experimental design, data collection and analysis.
  If I am discussing specific healthcare products or services, I will use generic names to the extent possible.  If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company.
  If I am discussing any product use that is off label, I will disclose that that use or indication in question is not currently approved by the FDA for labeling or advertising.
  If I have been trained or utilized by a commercial entity or its agent as a speaker (e.g., speaker’s bureau) for any commercial interest, the promotional aspects of that presentation will not be included in any way with this activity.
  If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principles and methods, and will not promote the commercial interest of the funding company.