Thank you for your interest in serving on a Spine Intervention Society (SIS) Division or Committee! As a volunteer organization, we depend on the time, effort, and expertise of our dedicated members to fulfill our mission and vision.
You are asked to complete this Disclosure survey in accordance with the Spine Intervention Society Disclosure Policy. The purpose of the disclosure policy is to protect the interest of the Society (“the Corporation”) when it is contemplating entering into a transaction or arrangement that might benefit the private interest of a director, officer, division or committee member, speaker, author on Society publications, or manager of the Corporation. This policy is intended to supplement but not replace any applicable state laws governing conflicts of interest applicable to non-profit and charitable corporations.
The potential for conflict of interest can exist whether or not the Discloser believes that the relationship affects his or her judgment.
This disclosure policy applies to all participants in any and all Society activities, including those who serve in committee and leadership positions within the society, including but not limited to, directors, officers, division members, committee members, speakers, faculty, instructors, authors on Society publications, and managers of the Corporation.
Disclosers must disclose any and all personal financial interests, affiliations, personal relationships (including family members such as spouse, domestic partner, parent, child, sibling), and other relationships perceived as potentially influencing the board, division, committee, or task force activities. Conflicts of interest include, without limitation, subject matter that has a reasonable potential to result in financial, professional, or other personal gain or loss for the Discloser, the Discloser’s family, employer, or other persons with whom Discloser maintains a relationship. The Discloser’s financial disclosure is based on a time period of one year prior to the survey's submission, the current year, and the foreseeable future.
For more information, please see the Spine Intervention Society Disclosure Policy, which is available on our Web site, www.spinalinjection.org.
Please mark "No Relationship" where applicable, otherwise all positive answers require a company name and relationship with entity.