Podcast Speaker Conflict of Interest Disclosure

1. GRANT OF RIGHTS: Subject to the terms and conditions herein set forth, the Assignor hereby grants and assigns exclusively to HealthCom the entire copyright and all rights protected thereunder in and to the Work, including Assignor’s contribution to the Work and any revisions thereof, in all languages, including, but not limited to: (a) the worldwide right to reproduce, prepare derivatives, distribute, perform, and display the Work, or any part thereof, in any publication in any medium or form of communication now existing or hereafter developed (including, without limitation, electronic media); (b) the worldwide right to license or syndicate use of the Work, or any part thereof, in any medium or form of communication now existing or hereafter developed, including without limitation, electronic republication; (c) the worldwide right to cause the Work, or any parts thereof, to be supplemented, revised, translated, abridged, dramatized, serialized, or otherwise adapted. Moreover, Assignor hereby waives all moral rights in the Work. In addition, Assignor grants to HealthCom the non-exclusive right to use the Work to promote and publicize HealthCom, its designated publisher of the Work (hereinafter “Publisher”) or its publications, including the right to use the As¬signor’s name, likeness and biographical data in such promotions.
2. COPYRIGHT: HealthCom shall have the right to secure copyright for the Work, and any renewals or extensions thereof, in their names in the United States and elsewhere. The Assignor hereby irrevocably appoints HealthCom, its successors and assigns, Assignor’s attorney in fact with power of substitution in the name of HealthCom to execute on Assignor’s behalf any and all documents necessary to carry out the terms of this Agreement. The Assignor agrees to execute any document that HealthCom or the Publisher may deem necessary to protect the rights granted hereunder.
3. WARRANTY: The Assignor represents and warrants that to the best of his/her knowledge: (a) the Work is original with him/her and that he/she is a contributing author and owner of the Work and that he/she has full power to make this Agreement; (b) the Work is not in public domain nor has any part of it been previously published; (c) no agreement to publish any or all of the Work is now outstanding; (d) the Work does not violate or infringe upon any copyright or other proprietary right; (e) the Work contains no matter which is libelous or otherwise unlawful, or which invades the rights of privacy of any person or party. These representations and warranties shall survive the termination of this Agreement and shall extend to HealthCom and HealthCom’s licensees, successors, agents, and assigns.
4. PERMISSIONS: If the Assignor incorporates in the Work any material which is subject to copyright protection, the Assignor agrees to immediately obtain written authorization to publish the Work and establish HealthCom’s authorship and ownership from the proprietor at the Assignor’s own expense.
5. RELEASE: Assignor for himself/herself and for his/her heirs, executors, administrators, successors, and assigns does hereby release and forever discharge HealthCom its predecessors, and each of their respective former and present members, managers, directors, officers, employees and agents from any and all claims, actions, causes of action, demands, rights, damages, debts, compensation, costs or other expenses of any nature whatsoever, including actual attorney fees, by reason of copying, publication, or republication by HealthCom or any of its assignees or licensees of any article or literary work heretofore provided to HealthCom by Assignor.
6. SUCCESSION AND ASSIGNMENT: This Agreement is binding on and inures to the benefit of HealthCom, its successors and assigns, and is binding on and inures to the benefit of the Assignor, the Assignor’s heirs, legal representatives, executors, administrators and assigns.

IN WITNESS WHEREOF the parties hereto have signed this agreement the day and year first above written.

This form documentation enables us to provide listeners with information about any potential conflict of interest that may influence how they perceive your work. A conflict may occur when a speaker has a financial relationship with a commercial entity that provides patient-related products or services that are relevant to the subject matter about which the speaker is presenting.

Each speaker should complete a separate form. The information provided should be based only on the past 36 months.

*If you are unsure if there is a commercial interest, refer to the explanation from the International Committee of Medication Journal Editors; Disclosure of financial and non-financial relationships and activities, and conflicts of interest at https://www.icmje.org/recommendations/browse/roles-and-responsibilities/author-responsibilities--conflicts-of-interest.html or contact Cheryl L Mee MSN, MBA, RN, FAAN executive editor director for HealthCom Media, at cmee@healthcommedia.com.