All individuals interested in being considered for an appointment to a CDA Guideline Development Group must submit a conflict of interest declaration.

A Policy for Declaring Conflict of Interests for CDA’s Guideline Development Authors as well as a supporting FAQ document have been created to identify what information is to be provided.

PLEASE READ THE POLICY AND FAQ DOCUMENTS CAREFULLY BEFORE FILLING IN THIS FORM.

Your declaration submission should list all interests in the 24-month time period leading up to your declaration submission, plus any new interests that will occur during the development of the guideline.

Submissions will be kept by the CDA and shared only with those involved in the process of approving these appointments.  If you have any questions please contact the CDA Director of Health Policy and Accreditation, Ms. Caroline Herzberg, at cherzberg@dermatology.ca or at 1-800-267-3376 ext. 226.

Question Title

A. Your details

Question Title

B.  Guideline topic(s) of interest

If you are interested in a number of topics, please indicate the order in which you would like to to be considered for them, i.e. 1 for first choice, 2 for second choice, and so no.  For any topic(s) not of interest, leave blank.

Question Title

C. Please provide information that will give the chair(s) insight into your knowledge and experience with the guideline topic(s) of interest. 

Question Title

If providing an attachment for Section C, please ensure it provides the required information.
File size limit is 16MB

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
Page1 / 2
 
 50% of survey complete.
( Privacy & Cookie Notice

T