Name of Activity / Session Month day, year
Description: Name of Activity Session Month day, year 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
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slide1. Name of Activity / Session
Month day, year<br>
slide2. 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:
[SPC member] 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: [insert generic and brand name here].<br>
slide3. Mitigating Potential Bias
[Explain how potential sources of bias have been mitigated by the scientific planning committee].
Refer to “COI Quick Tips” document<br>
slide4. Faculty/Presenter Disclosure
Faculty: [Speaker’s name]
Relationships with financial sponsors:
Grants/Research Support: [PharmaCorp ABC]
Speakers Bureau/Honoraria: [XYZ Biopharmaceuticals Ltd.]
Consulting Fees: MedX Group Inc.
Patents: [Widget ABC]
Other: [Employee of XXY Hospital Group]<br>
Month day, year<br>
slide2. 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:
[SPC member] 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: [insert generic and brand name here].<br>
slide3. Mitigating Potential Bias
[Explain how potential sources of bias have been mitigated by the scientific planning committee].
Refer to “COI Quick Tips” document<br>
slide4. Faculty/Presenter Disclosure
Faculty: [Speaker’s name]
Relationships with financial sponsors:
Grants/Research Support: [PharmaCorp ABC]
Speakers Bureau/Honoraria: [XYZ Biopharmaceuticals Ltd.]
Consulting Fees: MedX Group Inc.
Patents: [Widget ABC]
Other: [Employee of XXY Hospital Group]<br>