ALPM Conflict of Interest Form

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*Page 1: General Information

The CFPC requires all presenters and members of Planning Committees to complete the CFPC Mainpro+® Declaration of Conflict of Interest form as part of the Mainpro+ certification process.

All speakers, moderators, facilitators, authors, and scientific planning committee members must complete this form. Disclosure must be made to the audience whether you do or do not have a relationship with a for-profit or not-for-profit entity.

Please review the instructions (pg 1-2) below:
https://bit.ly/2Jz9vSC

Name *

Organizational Affiliations: I HAVE/HAD an affiliation (financial or otherwise) with a for-profit or not-for-profit organization. *

These include health care employers, university and other institutional affiliations (CSPCP, CHPCA, Pallium, etc...)

Yes

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