1 Start 2 Complete Full Name * Email * GTSC Presentation Release: * As a prospective planner or faculty member, we would like to ask for your help in protecting our learning environment from industry influence. The ACCME Standards for Integrity and Independence require that we disqualify individuals who refuse to provide this information from involvement in the planning and implementation of accredited continuing education. Thank you for your diligence and assistance. I hereby grant the General Thoracic Surgical Club (GTSC) permission to publish and distribute my PowerPoint slides and a video recording of my presentation on the GTSC website. I give GTSC permission to use my name and biographic information to promote the presentation. I waive any right to royalties or other compensation arising or related to the use of my PowerPoint. I do not want my presentation published. GTSC Please indicate your year(s) of training. * < 1 year 1 - 5 years 5 - 10 years > 10 years I have secured necessary permission(s) or copyright clearance(s) for any data, illustrations, photographs or any other content requiring permission for use in this educational context. * Yes No I understand that it is my responsibility to disclose to the audience when my discussion includes non-FDA approved indications or dosing recommendations. * Yes No Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20232024202520262027 Leave this field blank
