Disclosure Statement of Financial Interest

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Presentation transcript:

Disclosure Statement of Financial Interest Presenting Author: Institution: Country: Within the past 12 months preceding this Congress, I have had a financial interest/arrangement or affiliation with the organisation(s) listed below. Affiliation/Financial Relationship Company Grant/Research Support Consulting Fees/Honoraria Major Stock Shareholder/Equity Royalty Income Ownership/Founder Intellectual Property Rights Other Financial Benefit Company One Company Two Company Three Company Four Company Five Company Six Company Seven

Disclosure Statement of Financial Interest I, (insert name) DO NOT have a financial interest/arrangement or affiliation with one or more organisations which could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.