In accordance with ACCME regulations, the American College of Surgeons must ensure that anyone who is in a position to control the content of the educational activity has disclosed all financial relationships with any commercial interests. Definitions can be found at:

http://www.accme.org/requirements/accreditation-requirements-cme-providers/policies-and-definitions/financial-relationships-and-conflicts-interest

All CME Planners and Speakers /Moderators/Discussants/Authors/Editors involved in the development and/or presentation of CME content must complete this form. The form must be updated whenever circumstances require it.

Failure or refusal to disclose or the inability to manage the identified conflict will result in the withdrawal of the invitation to participate.

If you do have a financial relationship(s) with commercial interests:

· List the names of companies that you (or your Spouse/Partner) have a financial relationship with currently or have had in the last 12 months.

· Explain what you (or your Spouse/Partner) received (i.e. salary, honorarium, etc.).

· Specify your role (i.e. consultant, board member, etc.)