1. Financial Disclosure Financial Interest / Affiliation
I hereby disclose any and all financial interest or “in kind” relationships with commercial organizations over the previous 2 years, not just those relevant to the subject being discussed.
Financial Interest / Affiliation
Name of Company(s)
Grant / Research support
Participation in clinical trial
Employment / Honoraria / Consulting fees / In-kind compensation
Investments (stock options, etc)
Membership on an advisory panel, standing committee, or board of directors
Other financial or material interest

2. Financial Disclosure
I do not have any affiliation (financial or otherwise) with a commercial organization that may have a direct or indirect connection to the content of my presentation(s).