The American Academy of Cosmetic Surgery Inc. (AACS) is an Illinois nonprofit corporation whose mission is to foster, promote, support, and develop the science, art, and practice of cosmetic surgery (“Exempt Purpose”). In furtherance of its Exempt Purpose, the AACS endeavors to provide educational programs related to cosmetic surgery, which reflect the applicable standards of care and best practices. First name: * Last name: * Credentials (MD, DO, PA, RN, etc.): Email address: * Activity title: * Date of the activity: * I AGREE TO THE FOLLOWING STATEMENTS: I am the presenting author completing this information. * I agree I hereby request and consent to participate as a faculty member in one or several of AACS Education events (“Meeting”) sponsored by the AACS. I agree to give the Presentation (s) I am submitting (“Presentation”). * I agree I will prepare the Presentation in PowerPoint or a digital format as instructed. * I agree I understand the AACS intends to record the Meeting. I hereby grant AACS a non-exclusive, royalty-free license to record the Presentation, to prepare a transcript of the Presentation, and to reprint, excerpt, display, sell, prepare translations and/or derivative works of, or otherwise make use of the Presentation, in whole or in part, in any media, whether print, audio, video, or other forms now known or hereinafter developed. I understand and agree that AACS will acknowledge my participation in the Meeting and my authorship of the Presentation, but I will receive no compensation and no other benefit with respect to the Presentation. * I agree I hereby represent that, to the best of my knowledge: (a) The content of my Presentation is accurate; (b) The Presentation does not violate any copyright, proprietary rights, or personal rights of others; (c) The materials, including photographs and video, used in this Presentation do not identify, by name or otherwise, suggest the identity of, or present a recognizable likeness of any patient or others; or, if they do, I have obtained all necessary consents from patients and others for the further use, distribution, and publication of such materials; (d) The Presentation will be educational, will not promote any specific product or service, and will not contain any false or misleading statements regarding any products or services or include materials that are anticompetitive, slanderous, libelous, or otherwise illegal, offensive, or inappropriate; and (e) I am authorized to make these representations. * I agree I agree to conform to all AACS and Accreditation Council of Continuing Medical Education (“ACCME”) guidelines and time limits applicable to my Presentation. I will fully disclose all financial support, proprietary interest, or consultant relationship with a manufacturer of a healthcare product or service (e.g., pharmaceutical, medical device) that is consumed by or used on patients that are used on patients, that is discussed in my Presentation. * I agree If my Presentation discusses any “off-label” or other non-FDA-approved, investigational use of a medical device or pharmaceutical product, I will disclose that the product or device is not labeled for the use under discussion or is still investigational. * I agree I understand that the AACS expects the Meeting to adhere to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. I represent that all recommendations for patient care must be based on current science, evidence, and clinical reasoning while giving a fair and balanced view of diagnostic and therapeutic options. All scientific research referred to, reported, or used to support or justify a patient care recommendation must conform to the generally accepted standards of experimental design, data collection, analysis, and interpretation. Suppose my Presentation promotes recommendations, treatment, or manners of practicing healthcare determined to have risks or dangers that outweigh the benefits or are known to be ineffective in treating patients. In that case, I will specifically make the learners aware. * I agree The AACME defines an ineligible company as an organization whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Examples of such organizations can be found at: https://accme.org/faq/what-accmes-definition-ineligible-company. I agree that I will not accept any financial or in-kind support from an ineligible company. This includes travel, lodging, honoraria, or any other expenses related to the education of the learners. * I agree I agree that the content of my Presentation and related materials will promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest. I understand that CME must be unbiased, scientifically rigorous, and include a balanced view of therapeutic options. I will use generic names whenever possible. If I include trade names in the Presentation materials, I will make reference to the trade names of several companies where available, not just the trade names of a single company. I understand that educational materials (slides, abstracts, handouts) must not contain advertising, trade names, or product-group messages. * I agree I hereby indemnify and hold harmless the AACS, its officers, directors, members, employees, and agents from and against any and all claims, expenses (including reasonable attorneys’ fees), and liabilities whatsoever arising, directly or indirectly, from any breach of my representations herein, or my actions or inaction at, or participation in, the Meeting. I further waive any and all rights I may have against AACS, its directors, officers, members, employees, and agents and release and discharge them from any claim relating to the Meeting or the manner in which it is conducted. * I agree I HAVE READ THIS FACULTY PARTICIPATION AGREEMENT AND AGREE TO BE BOUND BY ITS TERMS. Name: * Leave this field blank
