Application for an ERS Research Seminar

To be submitted (including all appendixes) by October 15, 2011 to:

ERS Headquarters, Ave Ste Luce 4, 1003 Lausanne, Switzerland at

General Information

a) Title of Research Seminar:

b) Assembly:

1. Clinical

2. Respiratory intensive care

3. Cell and molecular biology

4. Clinical physiology and integrative biology

5. Airway diseases

6. Occupation and epidemiology

7. Paediatrics

8. Thoracic surgery and transplantation

9. Allied respiratory professionals

10. Respiratory infections

11. Thoracic oncology

12. Other topics

c) Objectives (150 words max):

d) Research Seminar Chairs:

Research Seminar chair (initiator) /
Research Seminar co-chair
Name:
Address:
E-mail:
Telephone:
Fax:

Logistical information

We would like to remind you that final contracts with venue, catering and hotels must first be approved by the ERS Headquarters and that the ERS can provide you with organisational support once the Research Seminar proposal has been approved by the Scientific Committee. The ERS office will liaise with the Research Seminar Chairs to find the best possible solutions, based on the wishes of the organisers, the experience of the office, the interests of the ERS and the budget constraints.

The Conferences and Seminars Director together with the ERS Office will consider your suggestion but maintain the right to change the location and venue in order to meet ERS Guidelines for Research Seminars.

a)  Organizer’s Institution - Central Institution within Europe

Upon proof that the location and venue can match the following criteria, the organisers can suggest to organise the Seminar in their Institution. :

•  Accessibility : a major international airport at max 30 km (a list will be provided with the application); the location must have access by public transportation

•  Price: affordable and within the budget (guidelines will be provided with the application)

•  Low Season: further confirmation can be provided by the ERS Office

•  City, country:

•  Name of the meeting venue:

•  Address:

•  Contact person and email (if known):

•  Suggestion for hotel/accommodation :

•  Address:

•  Contact person and email (if known):

•  Transfers from and to the airport required: yes no

If no institution is proposed, a choice of 3 central locations defined by ERS: (please list your preferences)

Berlin (institution)

Barcelona (hotel)

Prague (hotel)

b)  Suggested dates and timing

Dates of the Research Seminar:

Start time on first day:

End time on last day:

c)  Participants (estimated number):

Number of faculty coming from Europe:

Number of faculty coming from overseas (please specifiy country/ies):

Number of bursaries (participants fully covered by ERS):

Number of self-funded participants:

Scientific Programme

a) Scientific justification for the organisation of the Research Seminar

(include literature review); 1000 words maximum

b) Aims and expected outcome; 500 words maximum

c) Detailed Scientific Programme, including presentations/faculty and breakout sessions

d) Faculty members’ proposal (Maximum 10 persons):

Including name, country, email address, 1-2 bibliographic references supporting the recommendation.

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Participants proposal

Please provide below a list of participants you wish to attend this Research Seminar.

We would like to remind you that the total number of participants accepted by the ERS will depend on the budget allocated, the maximum being 100. 50% of the total number of participants at the Seminar can be suggested by the Research Seminar Chairs, the remaining 50% will be selected from the applications received.

Chairs will be contacted on a regular basis for participants’ selection.

Suggested list of participants (name, country and e-mail required):

Collaboration with other societies

a) Is collaboration with another scientific society intended? yes no

If yes, please specify

·  which society:

·  the nature of contribution expected by the other society (type of funding, amount, and if already approved or pending):

Budget

b) Maximum budget:

c) Have you identified a sponsor? yes no

If yes, please specify which company and the amount:

Conflict of interest

The Research Seminar Chair and Co-Chair must both provide duly completed and signed conflict of interest forms with the Research Seminar application.

Reports and final documents

It is furthermore agreed that any statement or other official communication in the name of the Society or of the ERS Research Seminar shall be submitted prior to publication for approval by the ERS Scientific Committee.

The statement or position paper developed by the ERS Research Seminar should be submitted and published in the first instance to the European Respiratory Journal or the European Respiratory Review.

We understand that the Research Seminar Chairs shall be forwarding a detailed report to the ERS Office, within 6 months of the ERS Research Seminar.

Date of submission:

Name of the Research Seminar Chair:

Signature: ______

Name of the Research Seminar Co-Chair:

Signature: ______


General Conflicts of Interests

(Speaker only)

I recognise that this continuing medical education (CME) activity is sponsored by the ERS. As such, the ERS must take responsibility for the content, quality and scientific integrity of this CME activity. Therefore, the ERS, as a provider of CME accredited by the EACCME or ACCME, must comply with the requirement to disclose to participants prior to educational activities the existence of any significant financial or other relationship a faculty member has with the manufacturer(s) of any commercial products(s) or provider(s) of any commercial service(s) discussed in a scientific or educational presentation.

I understand that the intent of this disclosure is not to prevent a speaker with a significant financial or other relationship from making a presentation, but rather to provide listeners with information on which they can make their own judgements. It remains for audience members to determine whether the Speaker’s interests or relationships may influence the presentation. The ERS does not view the existence of these interests or commitments as necessarily implying bias or decreasing the value of the speaker’s presentation.

Please complete and tick R the following statements as appropriate:

Speaker’s Name: ______

Title of CME Activity in which the faculty is presenting: “______”

Date of presentation*: DD/MM/YYYY

Lecture Title*: “______”

* Please complete a separate form for each lecture which you will present, as disclosures are presentation-specific.

ð  Yes, I have the following, real or perceived conflicts of interest that relate to this presentation. I understand that I have to disclose these conflicts of interest on a slide at the beginning of my presentation: describe here the conflict you have ______.

ð  No, I have no, real or perceived, conflicts of interest that relate to this presentation.

Tobacco-Industry related conflict of interests

European Respiratory Society's policy on tobacco industry funding: Any invited Faculty who has current funding from the tobacco industry, or has any perceived links with the tobacco industry (such as holding shares, or speaking at or attending meetings organised by the tobacco industry) will not be allowed to act or participate in any ERS Event. In addition, studies funded in part or wholly by tobacco industry funding will not be accepted for publication.

If a person declares a current tobacco industry conflict of interest, there will be a 12-month ban before he/she is allowed to act or participate to any ERS event. In the situation that an undeclared conflict is discovered, there will be a 5-year ban before the person is allowed to act or participate in an ERS event.

In the interests of transparency, it is advised that you also declare any previous tobacco industry funding on their Statement of Interest form, specifying the dates that funding was received.

ð  I declare that I have NO relationship of any kind with the Tobacco Industry either in the last 12 months (as per “today’s date”) nor will have a link to the Tobacco Industry before the event to which I have been invited by the ERS to participate in, such as an employee, consultant, grant beneficiary (By grant is meant any support whether in cash or kind, and includes for example; funding or funds for research, equipment, facilities, consumables, travel, reimbursement for attending an event, personnel), shareholder, sponsored researcher/scientist or other: ______(please specify).

The ERS no longer acceptsFaculties (Participant of Research Seminar, Chair or Speaker) who havelinks with the tobacco industry, and reserves the right to take appropriate measures to preserve its interests. Unless your answer is “no relationship” to the declaration above, the ERS will have to cancel this invitation.

Signature:Date (DD/MM/YYYY):

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