Request for Approval of Industry-Sponsored Speaking Engagement

Complete the information below and attach the contract from the Company in Word format for this speaking engagement request. For more information regarding Industry-Sponsored Speaking Engagements, see: http://www.ucdenver.edu/academics/colleges/medicalschool/facultyAffairs/RulesPolicies/Pages/RulesPolicies.aspx.

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Speaking Engagement Information

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If yes, include name of the company providing compensation.

Focus of Speaking Engagement*

Does the speaking engagement focus on specific drugs, products or devices?

If yes, please provide additional information about the purpose of the talk (e.g., whether the purpose is to provide information of general scientific interest and concern).

Speaking Engagement Materials*

Are you expected or required to use any slides, handouts or other materials prepared by industry; or are you required to submit your slides, lecture notes, handouts or other materials to industry for approval?

Speaking Engagement Contract

Were you provided with a contract for this speaking engagement?

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Contract Language

Note that the following language, which has been approved by the Industry-Sponsored Talk Approval Committee and CU Medicine legal counsel, must be included in all speaking contracts. If this or similar language is not included in the contract, or an email from the company agreeing to the language is not included with this request, you will be notified that the request is incomplete and the request will not be reviewed until the information is submitted: "With regard to any presentation delivered by Speaker at the request of the Company pursuant to this Agreement, Speaker will have exclusive control over the content of any such presentation, including any accompanying presentation materials, handouts, or slides, based on Speaker's expertise and independent, objective professional judgment. The content of such presentations, including any accompanying materials, handouts, or slides, will not be subject to the review or approval of the Company, except that the Company may review handouts, slides and other materials for the sole purpose of ensuring compliance with FDA regulations. In additional, any such presentation will be for the purpose of providing information of general scientific interest and concern, and will not be focused on the marketing and promotion of the Company's products."

Income Assignment

Assuming your speaking engagement is approved, it is your responsibility to review the policies regarding assignment of income associated with this speaking engagement. Please note that income received from approved industry-sponsored speaking engagements does not need to be assigned to CU Medicine if the speaking engagement is a one-time event. "One-time" means that the faculty member will not engage in repeat presentations for the same company, non-profit institution or other sponsor. Click here to review Assignment of Income Document: http://www.ucdenver.edu/academics/colleges/medicalschool/facultyAffairs/Documents/UPIDocument2012.pdf.

Income Assignment*

If you are not assigning this income to CU Medicine, please indicate the reason.

Submission of Request

Click the box below if you wish to receive a copy of this submission by email, then click "Submit." Once submitted, you will receive a response to your request within 10 business days. If you have any questions, please contact Cheryl Welch @ cheryl.welch@ucdenver.edu or 303-724-5356. Thank you for your patience with this process.

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