Over the next few months, NASS will be reviewing committee appointments for the coming year. If you are interested in serving a three-year term on a NASS committee, please indicate below. More information on these committees can be viewed here.

NASS may require divestiture of certain relationships within our committees in accordance with the (attached) “NASS Policy on COI in Leadership Positions”. The level of divestiture required of each committee is listed after each committee below (Level I, II,III). NASS requires disclosure of your financial relationships and a completed committee application prior to your consideration for service on our committees. The full online disclosure module can be found: http://disclosure.spine.org. If you have already completed the module, please ensure all your disclosure information is accurate. This online module adheres to the new disclosure policy which requires, among other things, specific dollar amounts for all relationships within the last 12 months. If you need your log in information, please contact Allison Pintauro. At the end of the module, please email yourself so you have a copy of your disclosure.

Please review the list of committees below before selecting your top 3 choices:

Please select your top 3 committee choices below:

1st:   *CME Committee – Level III Section on Motion Technology – Level III Section on Allied Health – Level III Public Affairs Committee – Level III International Education Committee – Level III Patient Education Committee – Level III *SpineLine Editorial Board – Level III *The Spine Journal Advisory Board – Level III – NASS Membership Not Required ______________________________ Research Project Management Committee – Level III – Active Membership Required Patient Safety Committee – Level III – Active Membership Required *Performance Measurement Committee – Level III – Active Membership Required **Evidence-based Guidelines Development Committee – Level III – Active Membership Required Research Survey Review Committee – Level III – Active Membership Required ______________________________ *Advocacy Committee – Level III – Active Membership Required **Professional, Economic & Regulatory Committee (PERC) – Level III – Active Membership Required *Coding Committee – Level III – Active Membership Required __________________________________________________ Exercise Committee – Level III Conflict of Interest Review Panel – Level I – Active Membership Required Ethics Committee – Level III – Active Membership Required Audit Committee – Level III Membership Committee – Level III Investment Committee – Level III Nominating Committee – Level III

2nd:   *CME Committee – Level III Section on Motion Technology – Level III Section on Allied Health – Level III Public Affairs Committee – Level III International Education Committee – Level III Patient Education Committee – Level III *SpineLine Editorial Board – Level III *The Spine Journal Advisory Board – Level III – NASS Membership Not Required ______________________________ Research Project Management Committee – Level III – Active Membership Required Patient Safety Committee – Level III – Active Membership Required *Performance Measurement Committee – Level III – Active Membership Required **Evidence-based Guidelines Development Committee – Level III – Active Membership Required Research Survey Review Committee – Level III – Active Membership Required ______________________________ *Advocacy Committee – Level III – Active Membership Required **Professional, Economic & Regulatory Committee (PERC) – Level III – Active Membership Required *Coding Committee – Level III – Active Membership Required __________________________________________________ Exercise Committee – Level III Conflict of Interest Review Panel – Level I – Active Membership Required Ethics Committee – Level III – Active Membership Required Audit Committee – Level III Membership Committee – Level III Investment Committee – Level III Nominating Committee – Level III

3rd:   *CME Committee – Level III Section on Motion Technology – Level III Section on Allied Health – Level III Public Affairs Committee – Level III International Education Committee – Level III Patient Education Committee – Level III *SpineLine Editorial Board – Level III *The Spine Journal Advisory Board – Level III – NASS Membership Not Required ______________________________ Research Project Management Committee – Level III – Active Membership Required Patient Safety Committee – Level III – Active Membership Required *Performance Measurement Committee – Level III – Active Membership Required **Evidence-based Guidelines Development Committee – Level III – Active Membership Required Research Survey Review Committee – Level III – Active Membership Required ______________________________ *Advocacy Committee – Level III – Active Membership Required **Professional, Economic & Regulatory Committee (PERC) – Level III – Active Membership Required *Coding Committee – Level III – Active Membership Required __________________________________________________ Exercise Committee – Level III Conflict of Interest Review Panel – Level I – Active Membership Required Ethics Committee – Level III – Active Membership Required Audit Committee – Level III Membership Committee – Level III Investment Committee – Level III Nominating Committee – Level III