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ANS ABSTRACT Conflict of Interest/Financial Disclosure Form - 2027

Financial Disclosure COI form ~ ANS 62nd Annual Spring meeting
April 9-10, 2027
Seattle, WA

In order to complete Part I of the ANS Abstract submission process, as the Primary author, please complete the following Conflict of Interest/Financial Disclosure form as it relates to you as the primary author.
If the Primary Author will not be the presenter, the Primary Author must also provide the required COI/Financial Disclosure information for the Presenter on this form. Co-authors (non speaking roles) are NOT REQUIRED to fill out a COI/FINANCIAL DISCLOSURE form.

You must indicate ONE of the following when submitting your abstract.
  • ORAL (will be considered for ORAL presentation only)
  • POSTER (will be considered for POSTER presentation only)
  • EITHER (Selecting this category does not lessen your chances of being selected for an ORAL presentation)
The preferred method of presentation (ORAL or POSTER) should be noted. If you select EITHER, the ANS Scientific Program Committee will make the final determination as to where to place your abstract.

The same submission rules apply for both POSTER and ORAL submissions. In order to be considered for an award, the abstract must first be selected by the Scientific Program Committee as an ORAL presentation, (you may submit as ORAL or EITHER).

ABSTRACT TITLE: Please choose your title carefully. Changes to titles will not be accepted once your abstract is selected for presentation.

Upon successful completion of the COI/Financial Disclosure form, you will be automatically directed to the ANS website and the Abstract submission form. Your abstract submission will be sent electronically to the ANS Administrative Office.

THANK YOU FOR YOUR COMPLIANCE!
Kristen Bordignon & Douglas Gossard
ANS Administrative Team

FROM THE AMERICAN COLLEGE OF SURGEONS, THE ACCREDITED CME PROVIDER:

In accordance with ACCME regulations (ACCME Standard 3), the American College of Surgeons must ensure that anyone who is able to control the content of the activity has disclosed all financial relationships with any ineligible companies in the 24 months prior to their involvement in the educational activity. There is no minimum financial threshold; we ask that you disclose all financial relationships, regardless of the amount, with ineligible companies.

Ineligible Company: Companies that are ineligible to be accredited in the ACCME system (ineligible companies) are those whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.

Financial Relationships: Financial relationships are relevant if the following three conditions are met for the individual who will control content of the education: 1) a financial relationship, in any amount, exists between the person in control of content and an ineligible company; 2) the financial relationship existed in the last 24 months; 3) the content of the education is related to the products of an ineligible company with whom the person has a financial relationship.

All CME Planners and Speakers/Moderators/Discussants/Authors/Editors etc. involved in the development and/or presentation of CME content must complete this form. This form must be updated whenever circumstances require.

Failure or refusal to disclose or the inability to manage the identified conflict will result in the withdrawal of the invitation to participate.
1.Please complete the following:(Required.)
2.Title of Abstract: This title must match EXACTLY with the title entered on your ANS Abstract Submission Form. Please choose your title carefully; changes to titles are not permitted once submitted. Trade names are permitted only when a generic term is not available or appropriate.(Required.)
3.What is your role in this CME Activity: (Check all that apply)(Required.)
4.I disclose the following:(Required.)
5.I have disclosed to the ANS all relevant financial relationships, and I will disclose this information to learners verbally for live activities and in print.(Required.)
6.I agree that I will not directly accept honoraria, travel expenses, in-kind contributions, or any other support from commercial companies in connection with this activity.(Required.)
7.If any of the information reported above changes, I will notify ANS immediately and update this form accordingly.(Required.)
8.By checking this box, I confirm that this abstract is being submitted exclusively to ANS and has not been submitted to another participating COSM society, including AOS.
I understand that duplicate submission to AOS or another participating COSM society will result in immediate disqualification of the abstract.(Required.)
9.As the PRIMARY AUTHOR, I certify that I have identified and disclosed all financial relationships with any ineligible companies (in the last 24 months) and that all information provided herein is true and correct.(Required.)
10.I am the primary author and presenter.(Required.)
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