Disclosure Slide Template

Report
Faculty Disclosures
ATS – 2013 / Philadelphia
<Type your name here>

Relevant financial relationships with a commercial interest:
< If you or your spouse/life partner, if any, DO NOT HAVE
one or more financial relationships with
commercial interest s that could be considered relevant to your presentation subject matter, please
remove the instructions within this text box except for the following line (only):
No relevant commercial interests.
(Retain the above line in at least 22 point type, centered as above. )
< If you or your spouse/life partner
DO HAVE one or more financial relationships with commercial
interests that could be considered relevant to your presentation subject matter, please instead replace the
instructions within this text box with a list of these relationships, using the format below (using at least 18
point type, a separate paragraph per company):
• Company Name, followed by the Type(s) of Relationship (e.g., Research
Grant) and on same line, whether that relationship is (Current) or (Past) or
(Expected). See Faculty Disclosure Slide Instructions memo for detailed instructions.
< Continue on additional slide(s) if needed. (See optional 3
rd
slide in slide set.)
Faculty Disclosures
ATS – 2013 / Philadelphia
<Type your name here>

“Off-label” use disclosure relevant to my presentation at
ATS-2013 / Philadelphia:
< Please disregard this slide if you DO NOT plan to discuss any “off-label” use during your presentation.
(See separate Disclosure Slide Instructions memo for more detailed instructions.)
< If you DO plan to discuss “off-label” use during your presentation, please instead replace the
instructions within this text box with that disclosure, using the format below (using at least 22 point type,
and a separate bulleted line per disclosure):
• Name
of the Commercial Product (use generic name rather
than brand name), followed by a brief description of the nature
of the off-label use discussed .
< Continue on additional blank slide(s) if needed. (See optional 3
rd
slide in slide set.)
Faculty Disclosures
ATS – 2013 / Philadelphia
<Type your name here>

If an additional slide is needed, please first type the category
title here (i.e., either: “Relevant financial relationships with a
commercial interests’ or “Off-label use disclosure”).
< Then type your additional disclosure(s) here, using the format
you used for your first slide of the same category. Use at least
18 point type.

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