The Clinical Laboratory Educators' Conference (CLEC) is a partnership between you, other faculty, the American Society for Clinical Laboratory Science (ASCLS), and its CLEC Program Committee to provide continuing education and networking opportunities for lab administrators, directors, supervisors, staff, educators, students and others in the field of clinical laboratory science. We are eager to publicize your participation in the CLEC program. We will appreciate both your cooperation in providing necessary information and your compliance with all program deadlines. Please review the following information, and submit your electronic signature by September 29, 2017. By submitting your information below, you understand and accept the terms of your participation as stated in this agreement. If you have any questions, please email email@example.com or call Pam Magnani at 703-679-2016.
This agreement confirms that the faculty member will:
ASCLS will provide the following:
ASCLS RESERVES THE RIGHT TO CANCEL THIS AGREEMENT IF FACULTY FAILS TO SUBMIT THE AGREEMENT AND OTHER APPROPRIATE COURSE INFORMATION BY THE SPECIFIED DATE.
The foregoing is in accordance with my understanding of our agreement. Amendments or changes to this agreement must be made in writing and must be signed by all parties.
The possibility for bias or a conflict of interest occurs when the financial interests of a speaker/author potentially preclude an unbiased, scientific presentation of a subject. The disclosure of possible conflict of interest is requested not to censor or exclude speakers, but to inform the audience so they may decide for themselves whether or not a presentation is biased. Information from this declaration will be disclosed to participants as follows: “Dr. Smith has research support from ABC Technology, Inc.” but will not be used to exclude speakers from an activity.
ASCLS requires all speakers in accredited Continuing Education Activities to disclose any possible bias or conflict of interest regarding the topic that is being presented. A conflict of interest is defined as any financial interest of the speaker in a company's products or services discussed in the presentation. For example, if the speaker (1) holds stock in the company, (2) is paid salary or consultant fees by the company, (3) has grant support from the company, and/or (4) has received support for travel expenses, honoraria, etc., from the company, a conflict of interest exists regarding this topic and must be reported. If the speaker has a financial interest in a company but is not discussing a product or service of that company, no conflict of interest must be disclosed.
Please complete the statement below as it relates to the topic of your presentation within the preceding 12 months.