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Title of Talk Speaker name

disclosure information Speaker Name: Disclosure of Relevant Financial Relationships I have the following financial relationships to disclose: Consultant for: (List company(s) here) Speaker’s Bureau for: (List company(s) here) Grant/Research support from: (List company(s) here) Royalties from: (List company(s) here) Stockholder in: (List company(s) here) Honoraria from: (List company(s) here) Employee of: (List company(s) here) I have no financial relationships to disclose. Disclosure of Off-Label and/or investigative uses: I will discuss the following off label use and/or investigational use in my presentation. (List products/ devices here) OR I will not discuss off label use and/or investigational use in my presentation. OR

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