CONDITIONS FOR PUBLICATION FORM THE ANNALS OF THORACIC SURGERY For submissions prior to February 1, 2015: FAX: (215) 614-0416; e-mail: [email protected] For submissions on or after February 1, 2015: FAX: (312) 268-5263; e-mail: [email protected] Online manuscript submission website: http://www.atseditorialoffice.org ATS#: Authors: Manuscript Title: This form MUST be completed, signed by ALL authors, and returned to The Annals of Thoracic Surgery before your manuscript can be accepted for publication. This form with signatures may be returned by fax or e-mail as noted above. 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CONDITIONS FOR PUBLICATION FORM I agree with the preceding conditions and provide the appropriate signatures and information below accordingly: CORRESPONDING AUTHOR SECTION (If corresponding author and senior author are the same person, that author should fill out this section only): Corresponding Author’s Name: Signature: Date: Author’s employer’s signature, if appropriate: U.S. Government employee: Yes No Conflict of interest: Yes No If yes, with which entity: Did you have freedom of investigation in all aspects of this work? Yes No Undisclosed writers have contributed to this paper: Yes No If yes, provide the writer’s full name, address and affiliation in separate correspondence. My contribution to this study included (check applicable items): study design; development of methodology; collection of data; analysis and/or interpretation of data; writing (not revising) all or sections of the manuscript; supervision; other, please specify I vouch for the accuracy and completeness of all of the data reported in the manuscript: Yes No SENIOR AUTHOR SECTION (If different person from corresponding author): Senior Author’s Name: Signature: Author’s employer’s signature, if appropriate: U.S. Government employee: Yes No Conflict of interest: Yes No If yes, with which entity: Did you have freedom of investigation in all aspects of this work? 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Yes No My contribution to this study included (check applicable items): study design; development of methodology; and/or interpretation of data; writing (not revising) all or sections of the manuscript; supervision; other, please specify Date: Author’s Name: Signature: Author’s employer’s signature, if appropriate: U.S. Government employee: Yes No Conflict of interest: Yes No If yes, with which entity: Did you have freedom of investigation in all aspects of this work? Yes No My contribution to this study included (check applicable items): study design; development of methodology; and/or interpretation of data; writing (not revising) all or sections of the manuscript; supervision; other, please specify Date: Author’s Name: Signature: Author’s employer’s signature, if appropriate: U.S. Government employee: Yes No Conflict of interest: Yes No If yes, with which entity: Did you have freedom of investigation in all aspects of this work? Yes No My contribution to this study included (check applicable items): study design; development of methodology; and/or interpretation of data; writing (not revising) all or sections of the manuscript; supervision; other, please specify Date: Author’s Name: Signature: Author’s employer’s signature, if appropriate: U.S. Government employee: Yes No Conflict of interest: Yes No If yes, with which entity: Did you have freedom of investigation in all aspects of this work? Yes No My contribution to this study included (check applicable items): study design; development of methodology; and/or interpretation of data; writing (not revising) all or sections of the manuscript; supervision; other, please specify Date: collection of data; collection of data; collection of data; collection of data; analysis analysis analysis analysis analysis If there are additional authors on the article, please photocopy this form and attach additional sheets as need be with appropriate information and signatures affixed.
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