Call for Reviewers

Please complete the entire form below. 

   
Member #*:  
First Name*:  
Last (Family) Name*:  
Designation:  
Institution:  
Email*:  
Primary Training:  
Unique PubMed Identifier String
Number of PubMed Citations:
How many journal articles have you published:
Have you reviewed abstracts for the ISMRM before?:
 
Please indicate three to five categories, in which you are both qualified and willing to review, in order of preference. As the review categories have changed this year, we suggest you view the full list of categories prior to making your selections HERE.
  Review Category Number and Description
(i.e. 001 Normal Brain Anatomy & Morphometry)
First Preference:
Second Preference:
Third Preference:
Fourth Preference:
Fifth Preference:
Sixth Preference
Seventh Preference
   

I     PARTICIPANT AGREEMENT: OBSERVANCE OF ISMRM POLICIES - MANDATORY

Please check each box below to acknowledge that you have read and understand each section, and will satisfy all these obligations and responsibilities of meeting organizers and speakers.

The content of CME activities does not promote the proprietary interests of any commercial interests.
   
Content of CME activities will be restricted to pure science, industry issues and operation of devices, and should not include product or company names unless essential (and subject to guidelines below).
   
Syllabus contributions, abstracts, and other required documents will be submitted as specified.
   
All recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.
   
All scientific research referred to, reported or used in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection and analysis.
   

 

Unlabeled Uses of Products.  When an unlabeled use of a commercial product, or an investigational use not yet approved for any purpose is discussed during an educational activity, the speaker is required to disclose that the product is not labeled for the use under discussion or that the product is still investigational.
   
Generic and Trade Names: Presentations must give a balanced view of  therapeutic options.  Use of generic names will contribute to this impartiality.  If trade names are used, those of several companies should  be used rather than only that of a single manufacturer.
   
To the best of my ability, I will ensure that any speakers or content I suggest is independent of commercial bias.
   
I will recuse myself from planning activity content in which I have a conflict of interest.
   
I will not accept additional compensation* from any organization due to my involvement with the ISMRM.
*Note: This does not preclude a faculty member from being reimbursed for expenses by their employer. This item limits only additional funding above reimbursements.
   
I attest that my opinions are my own and are not reflecting the opinions of my employer or other association.
   

II. DECLARATION OF FINANCIAL INTERESTS OR RELATIONSHIPS:

The ISMRM is committed to

1. ensuring balance, independence, objectivity and scientific rigor in all Continuing Medical Education programs, and
2. presenting CME activities that promote improvements or quality in healthcare and are independent of the control of commercial interests.

As part of this commitment, the ISMRM has implemented a process in which speakers and everyone else who has influence upon the content of an educational activity discloses all financial relationships with any commercial interest, of any extent within the last 12 months (click on links for definitions). In addition, should it be determined that a conflict of interest exists as a result of a financial relationship, this will need to be resolved prior to the activity. This information is necessary in order for us to be able to move to the next steps in planning this CME activity.

If you do not complete this form, whether or not you have relevant financial relationships, you will be disqualified from participating in the planning and implementation of this CME activity.

Affiliations and financial interests disclosed will be indicated in program and syllabus listings and in each talk. ISMRM does not imply that such financial interests or relationships are inherently improper or that such interests or relationships would prevent the speaker from making a presentation. The intent is that any conflict should be identified, resolved and disclosed so that listeners may form their own judgments about the presentation in the light of full disclosure of the facts.

The declaration applies to any real or apparent financial interest or other relationship (i.e., grants, research support, consultant, honoraria, etc.) that the individual may have (or have had within the last 12 months) with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. This disclosure requirement extends to interests/financial relationships of spouses/partners. It does not apply to relationships with non-profit or governmental bodies.

INSTRUCTIONS


First,
indicate in the Declaration Statement whether or not you have a relevant financial interest or relationship.
 
Second
, if you have relevant financial interests, describe them under either:

A) Grant and Research Support,

B) Employment, or

C) Other types of relationships.  

Give the names of relevant commercial entities.  A drop-down list of some company names is provided.  If the particular company does not appear on this list, please enter the name in the space provided. Relationships with non-commercial entities such as universities, hospitals, government agencies, foundations and non-profit societies are not to be included.

For “Other types”, provide a description of the relationship, what was received, and the name of the company. Drop-down lists are provided.  If your particular entry does not appear on these lists, please describe it in the spaces provided.  The ISMRM does NOT want to know how much you received.  Please do not provide the amount.

Note:  If you have more than one of a type of financial interest or relationship to disclose, please complete this form separately for each disclosure.


       
 DECLARATION
STATEMENT

Check 1 OR 2 below, whichever applies to you; if you have checked 2 please describe financial interests/relationships in  space provided.

1. I have no actual or potential conflict of interest in relation to the subject/content of this program.
   
2. I (or my spouse/partner) have a financial interest/arrangement in the last 12 months with one or more organizations that could result in or be perceived as a real or apparent conflict of interest in the subject of my presentation/the program. (If you have checked "2" please give names of companies/organizations and types of relationship below.

A.    GRANTS AND RESEARCH SUPPORT (choose from drop-down menu): 

1.   

Other: 

2. 
 

Other: 


B.  EMPLOYMENT (choose from drop-down menu):



Other: 



C.    OTHER TYPES OF FINANCIAL INTERESTS:

RELATIONSHIP (choose from drop-down menu): 



Other:

WHAT WAS RECEIVED (choose from drop-down menu): 

Other:

RECEIVED FROM (choose from drop-down menu):



Other: 

If you have another financial interest/relationship to disclose, please press "submit" and fill out the form again for each additional one. 

   
 
  *required field