ICS - DECLARATION OF POTENTIAL CONFLICT OF INTEREST (COI) FORM

DECLARATION OF POTENTIAL CONFLICT OF INTEREST (COI) FORM
Download the COI form from HERE, fill it in, and then upload it below
Name*

First NameLast Name
Email*
example@example.com
Please check the following, as applicable*

SpeakerModeratorScientific planning committee memberFacilitator
Please complete, if applicable:
Presentation/Session Title 1
Learning Objectives 1
Presentation/Session Title 2
Learning Objectives 2
Presentation/Session Title 3
Learning Objectives 3
Please upload your completed COI form*

Cancelof
I have declared a COI in my completed form*

YesNo
Should be Empty: