Declaration for individual researchers (Standard KBS format)

Please provide details of any funding you have received in the past 5 years from an alcohol industry body, or from an organisation receiving funding from the industry, e.g. ERAB, ABMRF, DrinkWise. "Funding" includes research costs, salaries, speaker fees, accommodation, transportation, and meals, but is not restricted to these.

I have not received alcohol industry funding of any kind in the past 5 years
I have received alcohol industry funding in the past 5 years (complete details below)
I am not sure if my funding is from industry sources (complete details below)

Details for each source of funding (name of funding source, nature of funding, period of funding):

1. General terms
All personal data passed on to the KBS Committee for KBS Society purposes will be treated as confidential. Limited personal data are collected, held for the following reasons and used in the following ways:
  1. for the performance of registration of membership,
  2. for communication to members of the society about KBS official activities, specifically, annual and thematic meetings and committee activities, .e.g., voting,
  3. for KBS symposia alongside abstracts and papers in the KBS archives - these details act as official records of the KBS symposia proceedings and contribute to research dissemination and collaboration.
The information will not be re-used for any purpose incompatible with the aims and functions of the society.

2. KBS Membership
In joining KBS I acknowledge that my name and email will be:
  1. used for the performance of registration of KBS membership and follow up,
  2. used to communicate to me about KBS official activities, specifically, annual and thematic meetings and committee activities, .e.g., voting,
  3. stored by the Co-ordinating Committee while I am a member and for up to 5 years after my last membership payment.
3. KBS Symposia
I understand that if I participate in KBS annual or thematic symposia that:
  1. my name and research presentation title will be made publically available as part of the program at symposia associated with the official KBS website www.kettilbruun.org,
  2. my abstract and draft paper will be archived at www.kettilbruun.org, along with my name and email in perpetuity (with these archives available only to KBS members),
  3. conference delegate emails will be used to promote future KBS symposiums and thematic meetings, but not for any other promotional purpose.
I agree with the "Privacy Statement"

From personal resources: € 35 per year
From institutional resources: € 80 per year

Renewal of membership: If you do not know your current payment status, please contact KBS Treasurer Elin K. Bye for an update

Personal resources Institutional resources
2019 € 35 € 80
2019-2020 € 70 € 160
2019-2021 € 105 € 240
Credit card (Visa, Mastercard, AmEx)
Bank transfer (details below)

Payments per credit card are to be done directly after submission of this form.

Date and time of submission: 22 October 2019, 05:59

Your IP address: 34.204.191.31

General information

Bank transfer

Kettil Bruun Society
DNB
Dronning Eufemias gate 30,0191 Oslo
Postboks 1600 Sentrum, 0021 Oslo
Norway
Account No. 15060362790
IBAN: NO4515060362790
BIC: DNBANOKKXXX

Treasurer

Elin K. Bye
Norwegian Institute of Public Health
Department of Alcohol, Drug and Tobacco Research
PO Box 4404, Nydalen, N-0403 Oslo, Norway
elin.bye@fhi.no