Conflict of Interest disclosure slide for representative speakers

Conflict of Interest disclosure slide for representative speakers or investigators Research fund □contract　□donation　□public scientific research fund □other （ 　 　　　　） Sponsor Name of lead presenter Institution or company/position No employee of company and/or profit-making organization ※１ □ adviser of company and/or profit-making organization ※２ □ profit of stock ※３ □ lecturer fees ※４ □ manuscript fees ※５ □ donations/contributions ※６ □ research expenses by contract with profit-making organization ※７ □ fees of testimony, judgment, comment, etc. ※８ □ gifts or any other payment ※９ □ If yes, please specify the name of company and/or organization, your status. 　 Name of principal investigator Institution or company/position No employee of company and/or profit-making organization ※１ □ adviser of company and/or profit-making organization ※２ □ profit of stock ※３ □ lecturer fees ※４ □ manuscript fees ※５ □ donations/contributions ※６ □ research expenses by contract with profit-making organization ※７ □ fees of testimony, judgment, comment, etc. ※８ □ gifts or any other payment ※９ □ If yes, please specify the name of company and/or organization, your status. 　 The Japan Lung Cancer Society

Conflict of Interest disclosure slide for representative speakers or investigators ( Lead presenter and principal investigator must describe the COI status from January 1 st, 2017 to December 31 st, which is related to the content of the publication. ) ※１ employee of company and/or profit-making organization ― ※２ adviser of company and/or profit-making organization $10, 000 or more annual compensation from a single business, entity, or group. ※３ profit of stock $10, 000 or more annual dividends, or 5% or more in the applicable business. ※４ lecturer fees $5, 000 or more annual income from a single company or organization. ※５ manuscript fees $5, 000 or more annual income from a single company or organization. ※６ donations/contributions $20, 000 or more annual donations/contributions paid by a single company or organization to you or your department. ※７ research expenses by contract with profit-making organization $20, 000 or more total annual research expenses paid by a single company or organization to you or your department. ※８ fees of testimony, judgment, comment, etc. $10, 000 or more annual judgment and comment etc, paid by a single company or organization. ※９ gifts or any other payment $500 or more annual gifts from a single company or organization, etc.