AASM 2021 Volunteer Application - American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers

Call for Committee Volunteers - Online Form

How to Volunteer for the AASM

Complete the required fields.
Select your first, second, and third choice of committee, opt-in/opt-out AASM Foundation, and AASM Mentor Program opportunities.
Provide your personal statement of interest and describe your current involvement with the AASM.
Complete the Conflict of Interest (COI) questions.
Upload your CV/Biosketch/Resume.
Complete the Copyright questions.
Hit "Submit" to send the form to AASM.

Step 1 - Personal Information

AASM member number*

Name*

First Last

Email*

Credentials/Degree*

Institution/Organization*

Location*

City State / Province / Region Country

Board Certified by ABMS*

YES
NO

Primary Specialty/Discipline*

ABSM Diplomate*

YES
NO

Step 2 - Committee and Volunteer Information

Click here to view a list of committees and their mandates.

Please select your first choice of committee from list below*

Please select your second choice of committee from list below

Please select your third choice of committee from list below

Would you be interested in serving as an application reviewer for the AASM Foundation strategic research, community or training award programs?*

YES
NO

Would you be interested in serving as a member of the AASM Foundation Research Fellowship Committee?*

Yes
No

Would you be interested in serving as a member of the AASM Foundation Development Council?*

Yes
No

View AASM Foundation Volunteer Opportunities

Would you be interested in serving as an AASM mentor?*

YES
NO

Learn more about AASM Mentor Opportunities

Step 3 - Personal Statement and Involvement

Please describe your current and/or previous AASM involvement (include role on the committee with dates)*

Please provide your personal Statement of Interest/overview of leadership activities that are applicable to the committee for which you are most interested in volunteering.*

Step 4 - Conflicts of Interest

Please view our American Academy of Sleep Medicine Policy on Conflicts of Interest.

Definitions:

Advisory Board: A group of individuals appointed to provide strategic advice to the leadership of a commercial (for-profit) or nonprofit organization; may also be called a council or panel
Board of Directors: A group of individuals, elected to represent a profit or nonprofit organization’s shareholders/members, who are responsible for setting the strategic direction for the organization and have overall responsibility for the activities and finances of the organization
Commercial entity: For-profit manufacturers, marketers and/or vendors of products and services
Consultant: A professional who provides expert advice in a specialized field or topic
Healthcare Association: A nonprofit, professional or patient membership organization, focused on healthcare, that individuals pay dues to join
Intellectual Property: A work or invention that is the result of creativity, such as a manuscript or a design, to which one has rights, and for which one may apply for a patent, copyright, trademark, etc.
Sleep Entity: A sleep laboratory, sleep facility or independent sleep practice
Speakers’ Bureau: A group of experts who are recruited and trained by a commercial entity to deliver information about the commercial entity’s products and/or services to other in their field

Conflicts of Interest: Please check "YES" or "NO" for each question. Only check "YES" if the relevant financial relationship occurred within the past 12 months.

Are you directly employed or serving as a consultant of a commercial entity (work related to sleep) where the total yearly non-investment income is ≥$25,000?*

YES
NO

For each conflict, provide the name of the company, start date (month/year) and end date (month/year or current).*

Are you directly employed or serving as a consultant of a commercial entity (work related to sleep) where the total yearly non-investment income is <$25,000?*

YES
NO

For each conflict, provide the name of the company, start date (month/year) and end date (month/year or current).*

If multiple conflicts are listed, is the combined total yearly non-investment income from all of the conflicts listed above ≥$75,000 per year?

YES
NO

Do you, a spouse, domestic partner or dependent own more than 5% of a sleep-related commercial entity?*

YES
NO

For each conflict, provide the name of the company, start date (month/year) and end date (month/year or current).*

Do you have knowledge of a close family member owning more than 5% of a sleep-related commercial entity?*

YES
NO

For each conflict, provide the name of the company, start date (month/year) and end date (month/year or current).*

Do you, or a spouse, own individual stock in a sleep-related commercial entity?*

YES
NO

For each conflict, provide the name of the company, start date (month/year) and end date (month/year or current) and indicate if the value is ≥$10,000.*

Have you accepted payments for speaking engagements from a commercial entity, except from an unrestricted educational grant or an ACCME accredited (or similar) program?*

YES
NO

For each conflict, provide the name of the company, start date (month/year) and end date (month/year or current).*

Have you received a personal gift, an institutional gift on your behalf, or discounted or free use of materials or equipment from a commercial entity of value ≥$1,000?*

YES
NO

For each conflict, provide the name of the company, type of gift/free use, start date (month/year) and end date (month/year or current).*

Are you directly employed or serving as a consultant related to establishment or accreditation of sleep entities?*

YES
NO

For each conflict, provide the name of the company, start date (month/year) and end date (month/year or current).*

Are you a member (paid or unpaid) of a Board of Directors or Advisory Board of a commercial entity (for profit) related to sleep medicine, excluding AASM SleepTM?*

YES
NO

For each conflict, provide the name of the company, type of work, start date (month/year) and end date (month/year or current).*

Are you a member (paid or unpaid) of a Board of Directors or Medical Advisory Board of another professional medical society or other healthcare association related to sleep medicine, excluding state and regional sleep societies and AASM-affiliated or AASM-managed organizations such as the AASM Foundation, the American Alliance for Healthy Sleep, the Associated Professional Sleep Societies and the American Board of Sleep Medicine?*

YES
NO

For each conflict, provide the name of the professional medical society or other healthcare association, type of work, start date (month/year) and end date (month/year or current).*

Are you a member (paid or unpaid) of a commercial entity’s speaker’s bureau?*

YES
NO

For each conflict, provide the name of the company, start date (month/year) and end date (month/year or current).*

Have you received a research or travel grant from a commercial entity of value ≥$1,000?*

YES
NO

For each conflict, provide the name of the company, start date (month/year) and end date (month/year or current).*

Are you a partial or sole owner of intellectual property related to sleep medicine that produces income or other monetary benefit? Do not include royalties or other payments from publishers for work.*

YES
NO

For each conflict, list the type of intellectual property, start date (month/year), end date (month/year or current) and indicate if the total yearly income or other monetary benefit is ≥$10,000.*

Conflict of Interest Signature*

I have read the American Academy of Sleep Medicine Policy on Conflicts of Interest and certify that the information provided is current and correct and that I am in compliance with American Academy of Sleep Medicine policy. I agree to inform the AASM immediately should any of the information change.

Please view our American Academy of Sleep Medicine Policy on Conflicts of Interest.

Step 5 – Upload Personal Documents

Upload your CV/Biosketch/Resume Here*

Drop files here or

(pdf, doc, docx, png, jpg)

Step 6 - Copyright

By checking each box below, you are confirming consent. Clicking the “Submit” button serves as your digital signature and agreement to the terms outlined on this form.*

That you hereby assign to the AASM all right, title and interest in and to your contributions to any publications, standards or other works created by the AASM [Board(s) , Committee(s) and/or Task Group(s)] in which you are participating, now and in the future (your “Contribution”).

*

To permit the AASM to use, publish or sell your Contribution for any purpose consistent with AASM’s above-mentioned mission.*

*

That your Contribution becomes the property of the AASM.*

*

To waive all rights that you may have for payments of royalties or other compensation in connection with the use, publication or sale of your Contribution.*

*

That you understand all of the information in this Copyright Assignment and that you have agreed to it knowingly, freely and voluntarily.*

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AASM 2021 - 2022 Volunteer Application

Call for Committee Volunteers - Online Form

Step 1 - Personal Information

Step 2 - Committee and Volunteer Information

Step 3 - Personal Statement and Involvement

Step 4 - Conflicts of Interest

Step 5 – Upload Personal Documents

Step 6 - Copyright

Step 7 - Submit

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