1. Conflict of Interest Disclosure (over the past 24 months)
Name: Dr. XXXX XXXX
Conflict of Interest Disclosure (over the past 24 months)
Commercial or Non-Profit Interest
Relationship
Organization
Committee member, Chair
Company A
advisory board, consultant, investigator
Company B
speaker
Company C
stockholder, employee
Company D
advisory board, research support

2. Conflict of Interest Disclosure (over the past 24 months)
Example of slide to use if no relationships to disclose
Name: Dr. XXXX XXXX
Conflict of Interest Disclosure (over the past 24 months)
No relevant relationships with any commercial or non-profit organizations