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. Terms, 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.

II. Terms, Duties and Responsibilities

TERM:
  • 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. One term is defined as the period in between two consecutive WCBIP congresses (therefore 1 term is approximately 2 years).
DUTIES & RESPONSIBILITIES:
  • 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
    • Society if the Regent cannot be located
  • Coordinate and supervise scientific and educational meetings aimed at participants at various levels of competency, to encourage and supervise teachings and research activities in his or her Member Society
  • Promote the WCBIP congress and encourage his/her local members to attend and submit abstracts and topic proposals for their country
  • Call a meeting of members he represents once a year and send a report to the Executive Committee regarding their proposals
  • Keep close contact with the Membership Committee by submitting proposals for educational activities and for strengthening WABIP in his/her own Member Society.

III. Conflict of Interest Policy, Rules and Disclosure


Disclosure

Your disclosures below. The WABIP COI oversight committee will evaluate your answers as it pertains to our Conflict of Interest Policy and Rules.

Must choose Yes or No. If Yes, please explain.
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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:

  • I agree to fulfill and uphold the Duties and Responsibilities of a Regent (Article II) to the best of my abilities should this Application be approved.
  • I shall fully comply with the Conflict of Interest Policy and Rules.
  • 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.
  • I have read and understood the entirety of this Application (Articles I – V).
Please type your signature.