Application for Board of Regents Membership


This online form ("Application") is for individuals who would like to apply for membership on the Board of Regents of the World Association for Bronchology and Interventional Pulmonology ("WABIP") in order to represent their Member Society constituents.


ARTICLES:
  1. Personal Information
  2. Duties and Responsibilities of a Regent
  3. Conflict of Interest Policy, Rules and Disclosure
  4. Upload Your Photo (Optional)
  5. Agreement
Please provide your information below. Required fields are denoted by "*".

I. Personal Information

Please type your full name.
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Please include member society.
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II. Duties, Responsibilities and Terms

• Represent the interests of his or her WABIP Member Society
• Engage actively in WABIP activities such as committees, taskforces, and workgroups
• Help identify ways for the WABIP and its Member Societies accomplish tasks and meet objectives
• Actively engage in voting on proposals and in elections presented to the WABIP Board of Regents
• Assist the WABIP accomplish its mission
• To encourage diversity among leadership, the maximum consecutive number of terms a Regent may serve is two (2) unless special circumstances dictate more than two consecutive terms as determined by the Member Society.

III. Conflict of Interest Policy, Rules and Disclosure

a. Policy
b. Rules
c. Disclosure (please fill out)
a. Policy

The World Association for Bronchology and Interventional Pulmonology is a global organization dedicated to promoting the art and science of bronchology and interventional pulmonology. This goal warrants that the WABIP expands areas of interest, scope of practice, products and services beyond procedure-related medicine to also include radiology, otorhinolaryngology, thoracic surgery, oncology, infectious disease, global health, and radiation oncology.

Considering the engagement of such an international group of practitioners, it is essential that the WABIP maintain credibility and integrity. The WABIP is, therefore, dedicated to ensuring scientific independence and unbiased objectivity to its educational, scientific, and research activities by advocating appropriate disclosure of real, perceived, or potential conflicts of interest.

The WABIP Conflict of Interest Disclosure Policy was designed to ensure transparency while protecting the integrity of individuals participating on WABIP taskforces, guidelines panels, writing committees or participating in other ways in the development and implementation of WABIP products or services. This policy thus provides a framework from which the WABIP and its COI/Guidelines Oversight Committee (COI/GOC) might evaluate and manage disclosures that could be viewed as potential, real, or perceived conflicts.

1. For purposes of the WABIP and the below COI Disclosure form, a COI is defined as any financial or other relationship with an entity that might have or be thought to have an effect on the participant’s judgment or conduct.
2. In addition, a COI is defined as any relationship with an entity whose products or services are the focus of a WABIP-related activity, and where the entity’s products or services are in direct competition with those of the WABIP.
3. Furthermore, a COI is defined for any participant with a financial interest or shared income (i.e spouse or family member) with a person or entity having a commercial interest in a related WABIP product or service.

This WABIP Conflict of Interest Disclosure Policy applies to all WABIP members or staff who:

1. Serve on WABIP Board of Regents, Executive Board, Committees, Administration, or Taskforces
2. Submit to or make presentations in a WABIP-sponsored activity or publication.

Please note that disclosure of a real, potential or perceived COI helps protect the integrity of the interested party and activity. Once COI is disclosed, the WABIP will be able to evaluate its possible effect or influence on WABIP products and services. If warranted, and upon recommendation from the COI/GOC, subjects may be asked by the WABIP Executive Board to refrain from participation in certain WABIP products or services.

This COI Disclosure Policy was approved by the WABIP Executive Board and accepted by the WABIP Board of Regents.

b. Rules

WABIP leaders are bound by COI rules according to their respective leadership levels during their term. Real or perceived COI changes depend on the level of leadership activities in the WABIP, and a person's decision making or advisory function in other professional organizations.

RULES FOR LEVEL I LEADERS
Applies to: Chair, Vice-Chair, Treasurer, and Secretary General

• No promotional activities (see POINTS OF CLARIFICATION section below).
• Except for investments in mutual funds, no holdings in stocks of pharmaceutical companies or any other commercial entities (e.g. device manufacturers) that manufacture or sell products related to management of individuals with disorders addressed WABIP.
• No investments in tobacco companies except for mutual funds.
• Disclosure of any activities, investments, or employment of a spouse, domestic partner or minors living in the same household that may be affiliated with pharmaceutical companies or any other commercial entities (e.g. device manufacturers) that make or sell products related to management of individuals with disorders addressed by WABIP.
• No service as board member or officer of any other national, regional, or international medical or professional society (see POINTS OF CLARIFICATION section below).
• No service as editor-in-chief or associate editor or deputy editor of a medical journal with content specific to WABIP-related official journals.
• Disclosure of activities as a member of any committee of any other national, regional, or international medical or professional society.
• No employment, consulting or advisory board activity for pharmaceutical companies and medical device companies, including WABIP sponsored focus groups, except as authorized by the WABIP’s decision making body on COI (see POINTS OF CLARIFICATION section below).
• No service as chair of a decision-making committee of any other national or international medical or professional society, except for limited exceptions as authorized by the WABIP’s decision making body on COI.

RULES FOR LEVEL II LEADERS
Applies to: WCBIP President, WCBIP President-elect, and Immediate past Chair WABIP, all members of the Board of Regents (Member Society representatives)

• No promotional activities (see POINTS OF CLARIFICATION section below).
• Except for investments in mutual funds, no holdings in stocks of pharmaceutical companies or any other commercial entities (e.g. device manufacturers) that manufacture or sell products related to management of individuals with disorders addressed by WABIP.
• No investments in stocks of tobacco companies except for mutual funds.
• No service as officer of another national, regional or international medical or professional society that is not a member society of the WABIP (see POINTS OF CLARIFICATION section below).
• No service as chair of a decision-making committee of any other national or international medical or professional society, except for limited exceptions as authorized by the WABIP’s decision-making body on COI. Serving as a committee member is permissible (see POINTS OF CLARIFICATION section below).
• Activities as a member of any committee or taskforce of another national, regional or international medical professional society must be disclosed.
• Activities as editor-in-chief or associate or deputy editor of a medical or professional journal with content specific to WABIP-related official journals must be disclosed.

RULES FOR LEVEL III LEADERS
Applies to: Members of WABIP committees, taskforces, workgroups (including Chairs and Vice-chairs), section editors, associate editors and other leadership positions of the WABIP Academy or WABIP Newsletter.

• Level III leaders must disclose any potential COI and recuse themselves from discussions when appropriate.
• Persons working on a WABIP-sponsored activity must submit a current COI disclosure form before, and sometimes, during the activity.

OTHER MATTERS

• Date of implementation of these COI rules: December 1, 2014.
• Notification of the adopted policy will be sent to all membersThese COI rules do not apply to members of the World Bronchology Foundation.
• Any clarifications of a COI should be submitted in writing to the COI committee for review and determination.
• Appeal to the decision of the COI committee will be referred, if necessary, to a special COI Appeals Committee consisting of FOUR MEMBERS: (1) The Chair of the COI Committee (serves as Chair), (2) A Member of the Executive Committee, (3) A member of the WABIP Board of Regents who is designated by the BOR and serves as liaison to the Board of Regents, and (4) a member of the WABIP Board of Regents who is designated by the Chair of WABIP. A Super majority (3/4) is required to reach a decision by this Appeals Committee. All decisions will be binding.
• The Conflict of Interest Policy, Rules and Disclosure document will be made available online for all WABIP leaders and members.
• Committee and taskforce chairs should begin every meeting (both remotely and inperson) by asking whether anyone has a new COI to disclose, including any COI related to a matter on the meeting agenda.

POINTS OF CLARIFICATION

• Promotional activities are defined as those intended to enhance the image, well-being, stature or popularity of a product or commercial entity. Promotional activities may or may not be remunerated. Examples include, but are not limited to, serving as a spokesperson or on a speaker’s bureau for a pharmaceutical company or medical device company, using a commercial entity’s audiovisual materials, or public endorsements of products.
• The restrictions on service for other professional medical societies are intended to avoid risk or perception of conflicting loyalties that could impair the WABIP and its best interests. These restrictions apply to national, regional, and international entities with interests that compete with WABIP activities. They do not limit a leader’s participation in local and state medical and professional societies or in hospital management, or in regional, national, or international societies that are member societies of the WABIP. Individual exemptions to these restrictions will be decided by the COI-OC and decisions may be reconsidered upon formal appeal.
• The restriction on work for pharmaceutical and medical device companies might limit a leader’s participation as a content expert for a company. Leaders who believe that their work for a company would not create an actual or perceived conflict of interest may seek formal authorization for an exception from the COI-OC.

c. Disclosure

Please provide disclosure to the best of your ability. The WABIP COI oversight committee will evaluate your answers for possible COI pertaining to existing or planned WABIP products and/or services.

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WABIP CASE EXAMPLES

1. Honoraria paid directly to an individual from third party CME providers do not need to be disclosed.
2. Honoraria paid directly to an individual from a company sponsoring or endorsing a CME event must be disclosed.
3. Honoraria paid by a company sponsoring research or education, and paid directly to the individual’s academic institution or department must be disclosed if the funds relate to the individual’s WABIP activity.
4. Honoraria and consulting fees paid by investment firms should be disclosed because these may have an impact on stock prices of pharmaceutical or manufacture companies.

IV. Upload Your Photo (Optional)

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V. Agreement

By providing my signature below, I hereby confirm and declare the following four statements (in bullet points):

• I have read and understood the entirety of this Application (Articles I – V).
• I agree to uphold the Duties and Responsibilities of a Regent (Article II) to the best of my abilities should this Application be approved.
• I agree to comply with the Conflict of Interest Rules (Article III.b).
• All information that I have submitted and disclosed to the WABIP in this Application is, to the best of my knowledge, true, accurate, and complete.
Please type your signature.