Speaker Disclosure Forms

Speakers, moderators and course organizers must complete both the Conflict of Interest disclosure form and the Terms and Conditions of Engagement to participate in ASSH education programs.

Learn more about the ACCME criteria for disclosure reporting.

Disclosures Form / Conflict of Interest:  

Even if you have nothing to disclose you must submit the COI reporting form.  Questions?  Contact the ASSH at meetings@assh.org.

1. Click on Disclosures within your ASSH profile (you will be prompted to login to access this section).
2. Review all instructions for disclosure reporting.

No Disclosures to Report:

The very first question will ask if you have any relationships to disclose.  If no, indicate "no" in response, leave all other fields blank and click submit at the bottom of the form.  Once submitted the system will timestamp your submission for ASSH record keeping.

NOTE: The last three questions only need to be completed if you are applying for a position on ASSH Council or the AFSH Board.  Includes: "positions in ASSH, relationships with other organizations and primary employer."

Financial Relationships to Disclose:

1. The very first question will ask if you have any relationships to disclose.  If yes, indicate "yes" in response and complete the appropriate fields provided.
2. DO NOT use abbreviations when listing corporate manufacturers. 
3. Leave all fields where you have no relationship BLANK.
4. Click Submit to record your response. Once submitted the system will timestamp your submission for ASSH record keeping.
5. NOTE: The last three questions only need to be completed if you are applying for a position on ASSH Council or the AFSH Board.  Includes: "positions in ASSH, relationships with other organizations and primary employer."

This form must be updated annually, however if any of this information changes, it is your responsibility to keep your profile up-to-date. 

This form must be completed separately for each ASSH course or meeting you are involved in. Click here to complete the form.

Please note: You must be logged in with your ASSH username and password to access this page.

1. Indicate the event which you participating in at the top of the page.
2. Carefully review the information on the page and click "I agree".
3. Complete the information required for each section.
4. If you have an FDA disclosure you are required to list the presentation title(s) this applies to, the name of the manufacturer and the drug/device in question.
5. All presenters must agree to terms and conditions of engagement to participate as faculty at an ASSH event.
6. If you are unable to agree to any listed term please contact the ASSH in writing at meetings@assh.org.

For questions or assistance, please contact the meetings department at meetings@assh.org or (847) 384-8300.