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2023 Satellite Symposium Budget FormSee Guidelines for Budgeting & Faculty Reimbursement (attached). Please forward completed form by Monday, November 14,2022 to the Tandem Meetings Office at TandemMeetings@mcw.edu or fax: 414.955.0221Planning Company Representative:Name of Commercial Supporter (Organization):Planning Company Mailing Address:Phone: Fax: E-mail:Satellite Symposium Title:EDUCATIONAL BASE GRANT – includes facility rental, CME administration, standard AV and food service, due in full by Friday,December 16, 2022. Deposit of 50% due Monday, November 14, 2022.ANTICIPATED EXPENSES – to be reconciled after the Meeting:*Tandem Meetings recommends stipends for US citizens and travel expenses for all speakers be paid bythe Planning Co.ANTICIPATED CHAIR & FACULTY STIPENDS* – MCW suggested stipends amount per speaker: 500. Chair Stipend [ ] check if chair is a US citizen Faculty Stipends ( x # of US speakers; x # of non-US speakers) Total Faculty Stipends (Chair stipend faculty stipends)ANTICIPATED CHAIR & FACULTY EXPENSECheck if expenses will be paid by Planning Company (see below) Conference Registration Fees Hotel Coach Airfare Ground Transportation Tolls and Parking Mileage @ 0.575/mile (current June 2020) Meals Other Expense specify: Other Expense specify: TOTALANTICIPATED MISCELLANEOUS SYMPOSIUM MANAGEMENT EXPENSE Meeting Management Company Fees & Travel Creative Development (Printing/Publications) Other Expense, specify: Other Expense, specify: TOTAL*Planning companies are strongly encouraged to obtain permission to prepay speaker expenses including travel and housing forall speakers and stipends for U.S. citizens, whenever possible to simplify accounting. If travel and/or housing is not prepaid,original ticket stubs with the original credit card statement used to pay for the travel and/or housing must be submitted beforereimbursement can be made, per Medical College of Wisconsin travel reimbursement policies. Missing documentation forexpenses will delay reimbursement and may result in tax consequences. All other expenses associated with the cost of the SatelliteSymposium including those payable to independent meeting management service providers or for creative development, printing,and publication costs, should, after approval from MCW, be paid directly by the Commercial Supporter. Full budgetary disclosure isrequired under CME regulations and detailed reconciliation and documentation is required.Tandem Meetings Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR February 15-19, 2023 Orlando, FL1
Guidelines for Budgeting & Faculty ReimbursementPlease use the following guidelines when preparing your Satellite Symposium budget and inviting faculty to present.COMMUNICATION WITH INVITED FACULTYCONFERENCE REGISTRATION FEESA list of all faculty, with professional and academic titles, fulladdress, telephone, fax and email address and administrativeassistant email addresses must be sent to Tandem MeetingsOffice at TandemMeetings@mcw.edu; fax: 414.955.0221prior to Monday, November 14, 2022. Copies of initialinvitation letters sent by the Commercial Supporter orPlanning Company to faculty should be included. Please referto the enclosed sample confirmation letter for CME-relatedverbiage that should be included in your letter to invitedfaculty.See www.astct.org or www.cibmtr.org for onlineregistration. Satellite Symposia planners are exempt frompaying the conference registration fee. Satellite SymposiaFaculty must be registered for the Tandem Meetings.Planning companies, after obtaining Tandem Meetings andMedical College of Wisconsin (MCW) approval, are stronglyencouraged to prepay travel, housing expenses andstipends for all speakers whenever possible, to simplifyaccounting. Each planning company will need a letter fromMCW as the CME Provider delegating fiduciaryresponsibility. Please submit a letter of request to TandemMeetings Office by December 29, 2022. If travel and/orhousing costs are not prepaid, original ticket stubs and anoriginal credit card statement used to pay for the traveland/or housing must be submitted before reimbursementcan be made, per MCW travel reimbursement policies.Missing documentation for expenses may result in delayedreimbursement and tax consequences. All other expensesassociated with the cost of the Satellite Symposium includingthose payable to independent meeting management serviceproviders or for creative development, printing, andpublication costs, should be paid directly by the PlanningCompany, after obtaining MCW approval to do so. Fullbudgetary disclosure is required under CME regulations anddetailed reconciliation and documentation is required.After the meeting, faculty will submit a Satellite SymposiumFaculty Reimbursement Form to the planner for signature,indicating approval of reimbursable expenses which have notbeen prepaid. The Travel Reimbursement Form with original(no photocopies) receipts for expenses and ticket stubs withoriginal credit card receipts (if not prepaid) will then beforwarded to Tandem Meetings by the representative forpayment.STIPENDSSuggested stipends amount per speaker: 500. Stipends arediscretionary; however, the MCW policy requires written preapproval for stipend payments exceeding 1,500 to any oneperson. Planning companies are strongly encouraged to payspeaker stipends, after obtaining Tandem Meetings and payspeaker stipends, after obtaining Tandem Meetings andMedical College of Wisconsin approval.AIR TRAVELFull coach should not exceed 1,000 for domestic andbusiness class fare should not exceed 5,000 for internationaltickets. Travel coordination should be done by thePlanner/Commercial Supporter as early as possible to attainlowest fares.GROUND TRANSPORTATIONGround transportation (taxi, airport shuttle, etc.) should bereimbursed at actual cost.HOTEL ACCOMMODATIONSHotel expense should be covered for a maximum of twonights: the night of the scheduled presentation and either thenight before or immediately after, not to exceed 300/night.Please make hotel reservations using the online housingreservation system, which will be made available on theregistration confirmation email.MEALS/PER DIEMMeals should be reimbursed with original receipts for amaximum of three days: the day of travel to the meeting, theday of the scheduled presentation and the day of travel home.The Medical College of Wisconsin recommends that mealsnot exceed 69 per day.AUDIOVISUAL REQUIREMENTSCost of standard audiovisual rentals and technical supportstaff, and ARS is included in the educational base grant.Additional AV expenses not included in the base grant andare the responsibility of the Planning Company.ADAPlease keep in mind that the Americans with Disabilities Act(ADA) mandates that Tandem Meetings, including allSatellite Symposia, must be completely accessible to allparticipants and faculty. Please contact the TandemMeetings Office at TandemMeetings@mcw.eduIMMEDIATELY regarding any faculty member requiringspecial accommodation.Tandem Meetings Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR February 15-19, 2023 Orlando, FL2
Satellite Symposium Disclosure of Commercial Relationships andAttestationsTitle of Accredited Activity: 2023 Tandem Meetings Transplantation & Cellular TherapyMeetings of ASTCT and CIBMTR – Satellite SymposiaName (speaker, author, teacher, planner):Role in the Activity: [ ] planner [ ] speaker [ ] reviewer [ ] monitorTitle of Speaker’s Presentation:Date of Activity: February 15-19, 2023Program ID: #23000If you indicate on this form that you have commercial interests, you are asked to discuss with the Activity Directorhow a possible conflict of interest will be resolved.First, list all the names of commercial interests (see last page for definition) with which you or your spouse/partner have orhave had a relationship within the past 12 months or know you will have in the future, whether you think they relate to thepresentation or not. Or check the No box below if you have no commercial interests. Proceed to the attestation on the secondpage.Second, describe what you or your spouse/partner received (i.e., salary, stipend, etc.). The Medical College of Wisconsin, Inc.does NOT want to know how much you received.Third, describe your role.Example terminologyWhat was received: Salary, royalty, intellectualproperty rights, consulting fee, stipends, ownershipinterest (e.g., stocks, stock options or other ownershipinterest, excluding diversified mutual funds), or otherfinancial benefit and/or patents.Role(s): Employment, management position,independent contractor (including contractedresearch), consulting, speaking and teaching,membership on advisory committees or review panels,board membership, and other activities (please specify).Tandem Meetings Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR February 15-19, 2023 Orlando, FL3
Nature of Relevant Financial Relationship (Include all thosethat apply)Name of Commercial InterestExample: XYZ PharmaceuticalsWhat was receivedFor What Role?StipendSpeakerI do not have any relevant financial relationships with anycommercial interests.Date Form Completed:By:Any details you can provide below about how your work with the commercial interest(s) does or does not relate to the contentof your presentation will greatly help the CME Office with the process of resolving any possible conflict of interest and approvingyour talk. For example, there would be no conflict of interest for someone who has received compensation for a presentation ona drug for acid reflux when their talk for the CME event will be on colitis.All speakers must complete this page. Unfortunately, disagreement will preclude being able tospeak at the meeting.Page 2:MCW Expectations: Please indicate your understanding of, and willingness to comply with, each statement below by checkingthe appropriate box. If you have any questions regarding your ability to comply, please contact us as soon as possible. Noalterations may be made to this form. Agree Disagree agree Agree Disagree N/AThe content and/or presentation of the information with which I am involved will promote quality orimprovements in healthcare and will not promote a specific proprietary business interest of acommercial interest. Content for this activity, including any presentation of therapeutic options, willbe well-balanced, unbiased, and based on best available evidence.I have not, and will not accept any honoraria, additional payments, or reimbursements beyond thatwhich has been agreed upon directly with the Medical College of Wisconsin (MCW).I understand that MCW may need to review my presentation and/or content prior to the activity, andI will provide educational content and resources in advance, as requested.If I am presenting at a live event, I understand that a CME monitor may be attending the event toensure that my presentation is educational, and not promotional in nature.If I am providing recommendations involving clinical medicine, they will be based on evidence that isaccepted within the profession of medicine as adequate justification for their indications andcontraindications in the care of patients. All scientific research cited in support of patient carerecommendations will conform to the generally accepted standards of experimental design, datacollection, and analysis. I will convey the limitations of the content being taught and the severe andmost common risks of treatments that are discussed.If I am discussing health care products or services, I will use generic names to the extent possible. If Ineed to use trade names, I will use trade names from several companies when available and not justtrade names from any single company.Tandem Meetings Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR February 15-19, 2023 Orlando, FL4
AgreeDisagreeN/AAgreeDisagreeN/AIf I am discussing any product use that is off-label, I will disclose that the use or indication in questionis not currently approved by the FDA for labeling or advertising.If I have been trained or utilized by a commercial entity or its agent as a speaker (e.g., speaker’sbureau) for any commercial interest, the promotional aspects of that presentation will not beincluded in any way with this activity. If I am presenting research funded by a commercial company,the information presented will be based on generally accepted scientific principles and methods andwill not promote commercial interest of the funding company.I have carefully read and considered each item in this form and have completed it to the best of my ability.Signature:Date:Return this completed form to the Tandem Meetings Conference Office by email TandemMeetings@mcw.edu orfax to 414.955.0221.Tandem Meetings Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR February 15-19, 2023 Orlando, FL5
This page is for your information only please do NOT return it to the CME OfficeThis is a different form from the one required of MCW faculty each year or for research grants. There are specificrequirements of the Accrediting Council for Continuing Medical Education (ACCME).The purpose of this form is to identify possible conflicts of interest and address them prior to the meeting.Circumstances create a conflict of interest when an individual has an opportunity to affect CME content aboutproducts or services of a commercial interest with which he/she has a financial relationship.Glossary of TermsCommercial InterestThe ACCME defines a “commercial interest” as any entity producing, marketing, re-selling, or distributing healthcare goods or services consumed by, or used on, patients. Companies that provide direct patient care such ashospitals and for-profit nursing homes, tissue/blood banks, non-profit or government organizations and nonhealth care related companies such as publishers are not considered commercial interests for CME purposes.RelationshipsRelationships include financial relationships in which the individual benefits by receiving a salary, royalty, intellectualproperty rights, consulting fee, stipend, ownership interest (e.g., stocks, stock options or other ownership interest,excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with rolessuch as employment, management position, independent contractor (including contracted research), consulting,speaking and teaching, membership on advisory committees or review panels, board membership, and otheractivities from which remuneration is received, or expected. Unpaid advisory board positions and research moneyor patents given to an institution on an individual’s behalf are also considered relevant relationships by the ACCME.Relevant relationshipsThe ACCME focuses on financial relationships with commercial interests in the 12-month period preceding thetime that the individual is being asked to assume a role controlling content of the CME activity. Known futurerelationships are also relevant. There is no minimal amount for relationships to be significant and unpaid advisoryboard positions are considered relevant. Relationships which are deemed relevant to be a planner or presenter atthis meeting will be disclosed to the audience/participants.PatentsIf a patent is owned by an individual, it is a relevant item and creates a relevant financial relationship. This must be disclosed tothe audience by referring to the owner of the patent by name and a description of what the patent is for.Tandem Meetings Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR February 15-19, 2023 Orlando, FL6
A list of all faculty, with professional and academic titles, full address, telephone, fax and email address and administrative assistant email addresses must be sent to Tandem Meetings Office at TandemMeetings@mcw.edu; fax: 414.955.0221 prior to Monday, November 14, 2022. Copies of initial
