Continuing Education

Research Symposium Abstract Submission

Conflict of Interest Statement

The potential for a conflict of interest exists when an individual has the ability to control or influence the content of an educational activity and has a financial relationship with a commercial interest, the products or services of which are pertinent to the content of the educational activity. Relationships with an commercial interest of the individual's spouse/partner may be relevant relationships • Evidence of a relevant relationship with a commercial interest may include but is not limited to receiving a salary, royalty, intellectual property rights, consulting fee, honorarium, ownership interest, grants, contracts, or other financial benefit directly or indirectly from the commercial interest. A confiict of interest would also occur if you have any potential to benefit personally or professionally from the presentation.

Conflict of Interest/ Disclosure

Is there a perceived financial conflict of interest (self or family)?

Yes No

If yes, describe the perceived conflict:

Primary Author Information

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Credentials (ex PhD, RN, FAAN) *

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Employer *

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List all - Degree(s) / Major(s) / Year awarded.

Briefly describe your expertise in the content area

Co-Author Information

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Co-author 1 First Name

Co-author 1 Last Name

Co-author 1 Credentials

Co-author 1 Email

Co-author 1 Employer

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Co-author 2 First Name

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Co-author 3 First Name

Co-author 3 Last Name

Co-author 3 Credentials

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Research Symposium Abstract Submission

Conflict of Interest/ Disclosure

Primary Author Information

Co-Author Information

Click submit to confirm your demographic data.

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