ࡱ> ^`]k bjbjZ Z 8!8cb8cb 8$x.$\!f2FPko)H0x!E`!J!CTx!B J:   CONFLICT OF INTEREST POLICY FOR CDE ACTIVITIES A conflict of interest may be considered to exist if a presenter is affiliated with or has financial interest in organizations that may have a direct interest in the subject matter of a Continuing Dental Education presentation. The prospective audience must be made aware of the affiliation or financial interest of the presenters by written acknowledgment in the program or verbal acknowledgment during the presentation. For example: John Doe, D.D.S. Professor, Department of Dentistry Research Consultant, XYZ Dental Products, City/State Or, if Dr. Doe has a financial interest: John Doe, D.D.S. Professor, Department of Dentistry Stockholder, XYZ Dental Products, City/State The intent of this policy is not to prevent a speaker with a conflict of interest from making a presentation. It is intended that any conflict should be identified openly so that the listeners may form their own opinions about the presentation with full disclosure of the facts. CONFLICT OF INTEREST DECLARATION AND SPEAKER AGREEMENT Program Title: Date: Name: I do not have any financial arrangements or affiliations with any corporate organization(s) and/or products mentioned in or providing support for this continuing dental education program. _____________________________ ________ Signature Date OR I have a financial interest/arrangement with one or more of the corporate organizations mentioned in or offering financial support for this continuing dental education program. Affiliation/Financial Interest Name/Corporate Organization(s) Grant/Research Support ________________________________ Consultant ________________________________ Speaker's Bureau ________________________________ Stock Shareholder ________________________________ Other Financial/Material Support ________________________________ Advertising, commercial promotion, solicitation, distribution of promotional materials or sales of any type are prohibited during the speaker presentation. Speaker represents and warrants that: speakers educational materials are original to Speaker or that s/he has obtained all third party permissions necessary to use them in Speakers presentation; Speakers use of educational materials will not violate the copyright or personal, proprietary or other right of any person or entity. ____________________________ ________ Signature Date Your cooperation in complying with these guidelines is appreciated. 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