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Additional Information I Informations supplémentaires
Speaker | Intervenant
Are you a speaker in a 90-minute session? Êtes-vous l'intervenant d'une session de 90 minutes ?
Conflict of Interest Disclosure
Have you completed the Conflict of Interest Disclosure?
Employment Sector | Secteur d'emploi
Select your main employment sector: Sélectionnez votre secteur d’emploi principal :
If other, please specify I Si autre, veuillez préciser :
Dietary Requirements I Restrictions alimentaires
Specify if you have any dietary requirements: Indiquez si vous avez des restrictions alimentaires :
If other, please specify / Si autre, veuillez préciser
Mobility Requirements I Aménagements spéciaux
Click Yes if you have requirements that may impede your mobility at the conference. The Conference Department will contact you so we can accommodate your needs.
Cliquez sur Oui si vous avez des besoins qui pourraient entraver votre mobilité lors de la conférence. Le service des conférences vous contactera pour que nous puissions répondre à vos besoins.
Please specify I Veuillez préciser
Emergency Contact I Contact en cas d'urgence
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Conflict of Interest Declaration
Examples of relationships that must be disclosed include:
Any financial or in-kind interest in a for- or not-for-profit entity relevant to the activity’s content or development
Investments held in the Organization;
Membership in the Organization’s advisory board or similar committee;
Funded grants;
Current or recent participation in a clinical trial sponsored by the Organization;
Membership in a speakers’ bureau;
Holding a patent for a product referred to in the CPD activity or marketed by the Organization;
Receiving honoraria to speak on behalf of a for- or not-for-profit organization (such as a pharmaceutical organization or medical communications company), including talks for which you have been contracted but have not yet received payment; and
All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity.
Select one of the following statements:
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Nature of the relationship
To ensure open and transparent participation in educational events, complete the appropriate Conflict of Interest field.
Important presentation requirements:
Content must provide objective information based on scientific methods generally accepted in the medical community.
Content must be free of commercial bias, and drug or product advertisements.
Data presented should be up to date.
A balanced view of therapeutic options should be presented.
Generic drug names must be used, or if brand names use several.
Financial Interest
Financial interest (e.g. stocks, stock options) or other ownership interest in the company/organization.
Membership
Membership in a for-profit or not-for-profit advisory board or similar committee.
Research Grants
Research grants funded by industry.
Clinical Trial
Participation in current or recent clinical trial sponsored by a pharmaceutical company or medical communications organization.
Speakers Bureau
Membership of a speakers' bureau.
Honoraria
Receiving honoraria to speak on behalf of pharmaceutical organization or medical communications company, including talks for which you have been contracted but have not yet received payment.
Patents
Holding a patent for a product referred to in the presentation.
Other investment or relationship
Other investments or relationships that could be interpreted as having the potential to influence the content of the educational activity.
Potential Bias
If you disclosed an affiliation (financial or otherwise), identify how you will address potential bias in your presentation.
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