Speaker Conflict of Interest Policy and Agreement

I understand that I must indicate below that either (a) I have no financial interest in any commercial entity whose products or services are described, reviewed, evaluated or compared in the Presentation; or (b) I have a financial interest in a commercial entity whose products or services are described, reviewed, evaluated or compared in the Presentation.  I must disclose any financial interest I may have in any commercial entity whose products or services are described, reviewed, evaluated or compared in the Presentation.  For example, I must disclose if I (i) have an ownership interest in such a commercial entity; (ii) have a financial interest in any product or service discussed in the Presentation; (iii) are employed (whether full or part-time) by such a commercial entity; (iv) own all or part of any patent licensed to such a commercial entity; (v) have an ongoing relationship (e.g., as a consultant, agent, representative, speaker, etc.) with such a commercial entity; or (vi) have received financial compensation for your Presentation.

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* 1. Select the option below that applies

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* 2. Declaration of Conflict of Interest

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* 3. If yes, please describe in detail (you may attach additional pages as necessary):

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* 4. Name:

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* 5. Signature:

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* 6. Date:

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