Leading Meeting Professionals

Professional Convention Management Association

December 2012

Full Disclosure

Carol Bialkowski
are accurate, you may return to the summary page and then confirm and save your disclosure.

* indicates a required entry

*1 Do you or a member of your immediate family receive royalties for any pharmaceutical, biomaterial, or orthopaedic product or device?

Yes I No

*2 Within the past 12 months, have you or a member of your immediate family served on the speakers bureau or have you been paid an honorarium to present by any pharmaceutical, biomaterial, or orthopaedic product or device company?

Yes I No

*3A Are you or a member of your immediate family a PAID EMPLOYEE of any pharmaceutical, biomaterial, or orthopaedic device or equipment company, or supplier?

Yes I No

*3B Are you or a member of your immediate family a PAID CONSULTANT for any pharmaceutical, biomaterial, or orthopaedic device or equipment company, or supplier?

Yes I No

*3C Are you or a member of your immediate family an UNPAID CONSULTANT for any pharmaceutical, biomaterial, or orthopaedic device or equipment company, or supplier?

Yes I No

*4 Do you or a member of your immediate family own stock or stock options in any pharmaceutical, biomaterial, or orthopaedic device or equipment company, or supplier (excluding mutual funds)?

Yes I No

* 5 Do you or a member of your immediate family receive research or institutional support as a principal investigator from any pharmaceutical, biomaterial, or orthopaedic device or equipment company, or supplier?

Yes I No

*6 Do you or a member of your immediate family receive any other financial or material support from any pharmaceutical, biomaterial, or orthopaedic device or equipment company, or supplier?

Yes I No

*7 Do you or a member of your immediate family receive any royalties, financial or material support from any medical and/or orthopaedic publishers?

Yes I No

*8 Do you or a member of your immediate family serve on the editorial or governing board of any medical and/or orthopaedic publication?

Yes I No

*9 Do you or a member of your immediate family serve on the board of directors or a committee of any medical and/or orthopaedic professional society?

Yes No

Reprinted with permission from AAOS.

MORE RESOURCES:

For more information about AAOS’s 2012 Annual Meeting, visit http://bit.ly/AAOS.

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