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REVIEW/APPROVAL FORM FOR WIDELY ATTENDED GATHERINGS (WAG) Name of Employee Igor Espinoza-Delgado, M.D. Signature of Employee Telephone Number 301.496.1196 IC (for blanket determination) Name of Supervisor James A. Zwiebel, M.D. Name of Conference or event (WAG) B elinostat Investigators Meeting Date of Request Saturday the 5 th of December 2009 Date of WAG Location of WAG Sheraton New Orleans Hotel, Southdown Room (4 th floor), 500 Canal Street , New Orleans, LA 70130 Time of WAG 7.30 – 9.00 pm Provided below are the elements that need to be assessed to determine if acceptance of an offer of free attendance is appropriate under the exception to the gift rule found in the Standards of Ethical Conduct for Employees of the Executive Branch (5 CFR Part 2635.204(g)). The employee initiating the request completes Questions 1-9. The employee should consult with the Ethics Coordinator (EC) to determine if Question 10 and all its elements must be addressed. The employee forwards the completed checklist to the EC for review and recommendation. 1. Is the employee assigned on official duty to participate as a speaker, panel member or otherwise to present information on behalf of NIH at a conference or similar engagement? Yes No x γ If yes, attendance on the day(s) of the employee's actual presentation is a customary and necessary part of his performance of the assignment and does not involve a gift to the individual or the NIH. No further action is necessary. γ If No, or the invitation includes attendance for days when the employee will not be making a presentation, proceed to Question 2. 2. Has someone other than the sponsor of the event designated the employee to be invited and will someone other than the sponsor bear the cost of the employee's attendance? NO γ If the answer to either is No, proceed to Question 3. γ
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