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ÑÇÉ«ÊÓƵ collects this information to evaluate and manage potential conflicts of interest and to satisfy continuing education accreditation requirements. Completion of this disclosure is required to participate as a speaker. The information will be retained through ÑÇÉ«ÊÓƵ’s next applicable accreditation review and as otherwise required by applicable recordkeeping requirements. For additional information about how ÑÇÉ«ÊÓƵ uses and protects your personal data, please see the .

All planners and presenters participating in accredited clinical education must complete this form to disclose any relevant financial relationships with .

If you disclose a financial relationship with an  on the Disclosure of Financial Relationships form, you must also complete this form.

If your presentation is streamed or recorded, you must complete this form to confirm your participation and acknowledge the applicable recording or streaming requirements.