Sample Disclosure Slide for Presenters

Presentation Title

Presenter’s Name

My disclosure along with my co-authors is listed in the disclosure index on the DVD-Rom of the Transactions

of the ORS 2012 Annual Meeting.

I have no potential conflicts with this presentation.

Presentation Title

Presenter’s Name

My disclosure along with my co-authors is listed in the disclosure index on the DVD-Rom of the Transactions

of the ORS 2012 Annual Meeting.

I have a potential conflict with this presentation due to…

One or more of the authors of the next presentation have identified the following potential conflicts of

interest.

1. Royalties2. Speakers Bureau/paid presentations3. Employee, Paid Consultant, or Unpaid Consultant4. Financial/Material Support5. Stock or stock options

One or more of the authors of the next presentation have identified the following potential conflicts of

interest.

6. Research or institutional support from company/supplier

7. Research or institutional support through department, division, or practice

8. Financial/material support from medical or orthopaedic publisher

9. Research or institutional support from medical and/or orthopaedic publisher

10. Research or institutional support from medical and/or orthopaedic publisher through department, division or practice.

Title of Talk

Jane Doe

My disclosure along with my co-authors is listed in the disclosure index on the DVD-Rom of the Transactions

of the ORS 2012 Annual Meeting.

I have a potential conflict with this presentation – Royalties received from ABC Company; Research support received from XYZ Company; stock in 123 Company, Inc.