1. Faculty/Presenter Disclosure
Faculty: [Speakers name]
Relationships with financial sponsors:
Any direct financial relationships including receipt of honoraria:
PharmaCorp ABC, Canadian Cancer Org.
Memberships on advisory boards or speakers bureau: XYZ
Biopharmaceuticals Ltd.
Patents for drugs or devices: Widget ABC
Other: financial relationships/investments Employee of XXY Hospital
Group, consultant for Company X
CFPC CoI Templates: 際際滷 1 used in Faculty presentation only.
2. Disclosure of Financial Support
This program has received financial support from [organization name] in
the form of [describe support here e.g. an educational grant].
This program has received in-kind support from [organization name] in the
form of [describe support here e.g. logistical support].
Potential for conflict(s) of interest:
[Speaker/Faculty name] has received [payment/funding, etc.] from
[organization supporting this program AND/OR organization whose product(s)
are being discussed in this program].
[Supporting organization name] [developed/licenses/distributes/benefits from
the sale of, etc.] a product that will be discussed in this program
CFPC CoI Templates: 際際滷 2
3. Mitigating Potential Bias
[Explain how the potential sources of bias identified in slides 1
and 2 have been mitigated by the scientific planning
committee, including any potential conflicts identified for
committee members].
Refer to Quick Tips document for information on how this
can be done
CFPC CoI Templates: 際際滷 3
Editor's Notes
#1: This slide must be visually presented to the audience AND verbalized by the speaker.
#2: This slide must be visually presented to the audience AND verbalized by the speaker.
#3: This slide must be visually presented to the audience AND verbalized by the speaker.