Author Agreement

The authors warrant the following:

The manuscript is original and each author has reviewed and approved the submitted version;

The manuscript is not under consideration by another journal and will not be submitted elsewhere while under review;

Written permission has been obtained for excerpts from copyrighted works, the original sources are credited in the paper; and copies of any publisher permission forms have been submitted.

Each author must print his/her name and sign below.

Name _____________________________________ Signature _____________________________

Part 2. Disclosure of Conflict of Interest.

Each author must reveal potential conflicts of interest, both financial and professional. Enter descriptive codes/codes below. Use all that apply. For values other than 0, please attach a brief explanatory paragraph.

0 = No financial relationship	1 = Paid consultant
2 = Patent ownership/part ownership	3 = Salaried by company/organization
4 = Royalty agreement	5 = Owner/shareholder of company
6 = Recipient of grant/funding from company

Name ______________________ Signature ____________________________ Code(s) __

Name _______________________Signature ____________________________ Code(s) __

Part 3. Compliance with requirements of Institutional Review Boards (IRB) and Health Insurance Portability and Accountability Act (HIPAA).

I, the designated corresponding author, certify that this submission complies with the IRB requirements of the institutions involved. For submissions of papers generated in the United States , I certify that this submission is HIPAA compliant.

Corresponding author Date

Return signed form by mail or fax to: Managing Editor, Journal of Spinal Cord Medicine, KMRREC, 1199 Pleasant Valley Way, West Orange, NJ 07052; 973 243 6970 FAX; 973 243 6880 phone; This email address is being protected from spam bots, you need Javascript enabled to view it