Note: (i) This section must be completed for all individuals identified
in the documentation of educational activities.
(ii) Alternatively, special forms that identify a vested interest may
be submitted in place of the section below.
Definition: An individual involved in the planning of or presentation
of an educational activity may have an interest in or affiliation with
an organization but the audience must be informed of this relationship
before the presentation of the activity. For this purpose, a real or apparent
conflict of interest is defined as personal gain or benefit derived from
involvement with any entity, product or service. Vested Interest includes
but is not limited to employment, by owning stock, from inclusion in a
speakers’ bureau or a relationship, personal or otherwise, with a
company that could potentially benefit from the relationship.
I recognize that I must follow all criteria regarding vested interest
and declare that: