2016 Continuing Medical Education (CME) Forums T he American College of Obstetricians and Gynecologists (the College) invites the industry to host CME Forums during the Annual Clinical and Scientific Meeting, but limits when those events may take place. The American College of Obstetricians and Gynecologists offers affiliates the opportunity to host Adjunct CME. These 90 minute sessions include a 15 minute meal, 60 minute program and should provide attendees with novel and innovative approaches to issues impacting physicians in the area of obstetrics and gynecology. Sessions are available at breakfast and evening time slots. Application Process To receive approval for an activity, applications must be completed and sent with the appropriate fee by April 15, 2016 . CME applications will be reviewed by the ACOG Committee on CME and processed on a first- come, first-served basis (and placed at the convention center pending space availability). CME Forums refer to any educational activity that is independently organized and held in conjunction with the 2016 ACOG Annual Clinical and Scientific Meeting. This includes any educational activity that carries Continuing Medical Education (CME) credit that is awarded by the American College of Obstetricians and Gynecologists (ACOG). All CME Programs must adhere to the following: • Program content must be developed independently, free of bias and cannot overlap with content currently being presented at the 2016 ACOG Annual Clinical and Scientific Meeting. • Program title must be indicative of the forum content. • Objectives must clearly meet the educational needs of the target audience. • Program must be presented in an objective, balanced and scientifically rigorous manner, cannot commercially promote a specific drug, product or service and must meet the policies and guidelines of the ACCME. • Content and related materials must promote evidence-based learning for optimum patient outcomes and patient safety. • Content cannot promote a specific proprietary business interest of a commercial entity. • Presentation must be fair and balanced when discussing specific products. If trade names are included in your presentation, trade names for several companies must be used where available. Audit To ensure compliance, your program will be reviewed and may be audited by members of the ACOG Committee on CME. Role of Faculty • Participating faculty must disclose all relevant relationships/interests using the ACOG online disclosure system so that ACOG can determine any potential or real conflicts of interests. • Faculty must be independent subject matter experts, scientists and/or clinicians. • Faculty must present an evidence-based, balanced presentation with a rigorous scientific review. • Product-specific promotional material or advertisement of any type is prohibited during the presentation. Leadership Participation Elected officials and chairs of committees and subcommittees directly and currently involved in the 2016 ACOG Annual Clinical and Scientific Meeting CME program are prohibited from participation in CME Forums, except as attendees who receive no honoraria or reimbursement. ACOG reserves the right to reject any proposed faculty member that it deems may have a conflict of interest with ACOG annual meeting activities. Sponsors whose programs are not placed due to lack of space or refusal of application will be refunded the total forum fee. No refunds will be given for forum cancellations unless the College cancels the event. If an affiliate is scheduling an event involving any of the Annual Meeting attendees or faculty in the city in which the College is hosting its 2016 Annual Meeting, the affiliate must complete the Forum Application and pay the appropriate fee. The following will be provided by ACOG: • Standard AV equipment including a riser with standing lectern, wired lavaliere microphone, panel table with chairs, LCD projector, DVD player, screen (sized appropriately for the room), sound system and extension cord • (2) lead retrieval units for data collection from session attendees • Registration services • AMA PRA Category 1 Credit™ /Cognate Credit CME Forums may be held for a fee of $30,000. The fee provides access to the Annual Meeting attendees and does not include food, airline travel, etc. 2016 Continuing Medical Education (CME) Forums 201 6 Annual Clinical and Scientific Meeting Washington Convention Center, Washington, DC n May 14-17, 2016 Third-Party Medical Education Provider Exhibitors that sponsor forums that choose to use a third-party planner must submit a letter on the Exhibitor’s letterhead notifying the College of the party planner’s company name, address, phone number, and any additional contact information. Forum Applications received from third- party planners without a letter from the Exhibitor sponsoring the forum will be rejected. The Exhibitor agrees that it will be held responsible for all actions of its third party planner, and any accident(s) or suit(s) arising from or in connection with the event. Compliance The supporter will be invited to participate with the expectation that the educational activity is held in accordance with the standards established by the Accreditation Council for Continuing Medical Education (ACCME), the AdvaMed Code of Ethics on Interactions with Health Care Professionals, the American Medical Association’s (AMA) Code of Ethics Opinion relating to Continuing Medical Education and Gifts to Physicians from Industry, the Food and Drug Administration (FDA) regulations regarding Industry Supported Scientific and Educational Activities, the Pharmaceutical Research and Manufacturers of America (PhRMA) Code on Interactions with Health Care Professionals and the Department of Health and Human Services’ Office of Inspector General (OIG) Compliance Program Guidance for pharmaceutical Manufacturers. It is strongly recommended that appropriate source and reference citations accompany all data presented in slides and program materials. Promotional Brochures and Invitations All announcements, invitations and covers should clearly indicate the name(s) of the sponsor of the CME Forum and the source of financial support for the event. The materials in no manner may imply, either directly or indirectly, that the forum is an official activity of the College. Materials related to the forum must not use language or terms such as “presented during,” “presented in conjunction with,” “preceding,” “prior to,” “following,” “live from,” in reference to the Annual Meeting. Use of the College logo, name, seal, or the Annual Meeting logo or name are also not permitted. Booth activities and symposium or special events cannot be promoted together on the same promotional literature. All marketing and promotional materials for all forums must include the following accreditation statements: • ACCME Accreditation The American College of Obstetricians and Gynecologists is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. • AMA PRA Category 1 Credit(s)™ The American College of Obstetricians and Gynecologists designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. • College Cognate Credit(s) The American College of Obstetricians and Gynecologists designates this live activity for a maximum of 1 College Cognate Credit. The College has a reciprocity agreement with the AMA that allows AMA PRA Category 1 Credit™ to be equivalent to College Cognate Credits. The Education Division must approve, prior to printing, all promotional announcements, invitations, and all materials intended for distribution to Annual Meeting attendees. In addition, all advertisements or invitation brochures must be approved in order to participate in any of the Annual Meeting marketing opportunities. All materials must be distributed through one of the Annual Meeting marketing opportunities (i.e. mailing labels, Doctor’s Bag, Obstetrics & Gynecology Journal (Green Journal), ACOG Today advertising, Final Program advertising, and/or Annual Meeting Show Daily advertising). Forum events may only be held during approved days and times. The College reserves the right to bar violators from participation in future meetings. Forum sponsors may not deny Annual Meeting attendee(s) access to their event (except due to space limitations). Sponsored events must be open to all Annual Meeting professional registrants. In this regard, the education provided at a forum should be consistent with the scientific evidence available, promote the professionalism, compassion and trust inherent in the physician/patient relationship and should not conflict with the mission of the College. Promotional or distribution schemes or products that create or potentially create financial conflicts of interest for physicians, or are of potential physical, emotional or financial harm to patients are prohibited. Likewise, exhibits that are actually or potentially discriminatory or demeaning to women, men, racial-ethnic populations, or any other groups are prohibited. Additional guidelines and restrictions may also be provided. Signage/Flyer Distribution Organizations may only advertise, promote or distribute information using the College’s marketing opportunities. At no time is distribution of promotional materials permitted anywhere within the convention center, hotel lobbies, shuttle buses, restrooms, or other common areas. Unapproved signs will be removed without advance notification to the Exhibitor and destroyed. Forums signs may only be placed in the convention center where the forum is scheduled to take place, on the day of the event, with written permission of the hotel management and the College. All signage must be submitted to the Education Division for approval. 201 6 Annual Clinical and Scientific Meeting Washington Convention Center, Washington, DC n May 14-17, 2016 2016 Continuing Medical Education (CME) Forums I/We agree to abide by all rules and regulations governing industry-sponsored symposia and events, (etc.) as set forth in the Exhibitor Prospectus, and any supported or related materials as it pertains to CME Forums. The American College of Obstetricians and Gynecologists (the College) reserves the right to deny any application for forums, if in the College’s opinion it does not serve the best interest of its members or is considered inappropriate. Limited meeting space is available. Forums application deadline is April 15, 2016 . M CME Forums ........................................................ $30,000 PLEASE TYPE OR PRINT Company Name Company Contact Company Address Company Phone Fax Email Please specify quantity and CME provider: ___________________________________ F orum Specifications Sunday, May 15 M Breakfast: 6:15am – 7:45am M Evening Reception: 5:30pm – 7:00pm M o nday, May 16 M Breakfast: 6:15am – 7:45am M Evening Reception: 5 : 30pm – 7:00pm Tuesday, May 17 M Breakfast: 6:15am – 7:45am Expected number of attendees: __________________________________________ W i ll food or beverages be served? M No M Ye s Ti t le of Forum: ___________ _ ___________________________________________ _ _______________________________________________ _ _________________ P l ease list all speakers below: (if more space is n e eded please attach an ad d itional page) 1 ) _____________________________________________ _ _ _________________ 2 ) ________________________________________________________________ 3 ) ________________________________________________________________ Conditions 1. STATEMENT OF PURPOSE: Program is for scientific and educational purposes only and will not promote the company’s products, directly or indirectly. 2. CONTROL OF CONTENT AND SELECTION OF PRESENTERS AND MODERATORS: Provider is responsible for control of content and selection of presenters and moderators. The company agrees not to direct the content of the program. The company, or its agents, will respond only to provider- initiated requests for suggestions of presenters or sources of possible presenters. The company will suggest more than one name (if possible); will provide speaker qualifications; will disclose financial or other relationships between company and speaker; and will provide this information in writing. Provider will record role of company, or its agents, in suggesting presenter(s); will seek suggestions from other sources; and will make selection of presenter(s) based on balance and independence. 3. DISCLOSURE OF FINANCIAL RELATIONSHIPS: Provider will ensure meaningful disclosure to the audience, at the time of the program, of (a) company funding and (b) any significant relationship between the provider and the company (e.g., grant recipient) or between individual speakers or moderators and the company. 4. INVOLVEMENT IN CONTENT: There will be no “scripting,” emphasis or direction of content by the company or its agents. 5. ANCILLARY PROMOTIONAL ACTIVITIES: No promotional activities will be permitted in the same room or obligate path as the educational activity. No product advertisements will be permitted in the program room. 6. OBJECTIVITY AND BALANCE: Provider will make every effort to ensure that data regarding the company’s products (or competing products) are objectively selected and presented, with favorable and unfavorable information and balanced discussion of prevailing information on the product(s) and/or alternative treatments. 7. LIMITATIONS OF DATA: Provider will ensure, to the extent possible, meaningful disclosure of limitations on data (e.g., ongoing research, interim analyses, preliminary data or unsupported opinion). 8. DISCUSSION OF UNAPPROVED USES: Provider will require that presenters disclose when a product is not approved in the United States for the use under discussion. 9. OPPORTUNITIES FOR DEBATE: Provider will ensure meaningful opportunities for questioning or scientific debate. 10. INDEPENDENCE OF PROVIDER IN THE USE OF CONTRIBUTED FUNDS: a. Funds should be in the form of an educational grant made payable to the _______________________________________________ (CME Provider). b. No other funds from the commercial company will be paid to the program director, faculty or others involved with the CME activity (additional honoraria, extra social events, etc.). The commercial supporter and accredited provider agrees to abide by all requirements of the ACCME Standards for Commercial Support of Continuing Medical Education. Acknowledge educational support from the commercial company in program brochures, syllabi and other program materials and upon request, furnish the commercial supporter a report concerning the expenditure of the funds provided. AGREED Commercial Company Representative (name) Signature Date CME Provider Signature Date Send application by April 15, 2016 to: ACOG Education Department Attn: 2016 Annual Meeting Product Theater 409 12th Street, SW, Washington, DC 20024-2188 For questions contact Jenny McIver at 678-852-3469 or email jmciver@mindspring.com . PAYMENT INFORMATION If paying by check, please make payable to ACOG 2016 Annual Meeting . If paying by credit card, please complete all of the information below to ensure that your credit card is accepted and your payment is approved. Credit Card Type: M Visa M MasterCard M American Express Amount to charge: $__________________ Credit Card #: _______________________________________________________ Exp. Date:___________________ CVN #: ________________________________ Printed Name on Card (as it appears): ______________________________________ Payment Authorized by: ________________________________________________ **** The appropriate fee must accompany this application to ensure processing. ****

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998