I consent to this Affidavit and Audio/Videotaping Release.   I affirm this proposal conforms to all of the LAFP’s submission instructions outlined.  I understand that a presentation is a requirement of all LAFP Assembly CME programs. I agree to provide this presentation at least six weeks before the meeting. I understand that my failure to provide the presentation by the deadline could result in the cancellation of my presentation and could adversely affect the acceptance of future proposals.  NOTE: Some programs are not audio/videotaped.

I acknowledge that I will prepare certain materials for distribution to program attendees and give LAFP and its designee’s permission to use these materials as noted above.

I acknowledge that my submission of this Faculty Agreement does not transfer my ownership rights in any materials and does not prohibit me from using my materials in any way I desire. This permission shall not expire and will not be affected even if I sell my copyright material.

I confirm that I am the sole author of the materials to be provided (except as noted below) and that LAFP’s use of these materials as described above will not infringe on the copyright of any other person or entity.

I further understand all speakers in this program must sign disclosure declarations and abide by the non-promotional guidelines set forth by the LAFP and the ACCME.

I have read and understand the LAFP policy on full disclosure. If I have indicated a financial relationship, I understand that this information will be reviewed to determine whether this relationship precludes my participation, and I may be asked to provide additional information. I understand that it is necessary to notify relevant staff and update disclosure information should my status change during the course of the CME activity. I understand that failure or refusal to disclose, false disclosure, or inability to resolve any relevant financial relationships will disqualify me from participating in this activity.