FacultyPresenter Disclosure Faculty Speakers name Relationships with financial

Faculty/Presenter Disclosure Faculty: [Speaker’s name] Relationships with financial interests: Grants/Research Support: Speakers Bureau/Honoraria: Consulting Fees: Patents: Other:

Disclosure of Commercial 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: [insert generic and brand name here].

Mitigating Potential Bias • Sponsor representatives are not members of the Planning Committee of the program • The Planning Committee carefully chooses the topics for the program in order to ensure that the principles of scientific integrity, objectivity and balance have been respected • The Planning Committee chair and members have individual discussions with each speaker regarding expected learning outcomes and teaching formats • The Planning Committee communicates the course learning objectives and requirement for scientific integrity, as well as instruction on conflict of interest disclosure and managing bias, to each speaker, facilitator and moderator