Conflict of Interest and Disclosure of Certain Interests
If any of the below questions are not relevant, please state not applicable in the answer fields.
Name
First Name
Last Name
Please describe below any relationships, positions, or circumstances in which you are involved that you believe could contribute to a Conflict of Interest, whether actual, potential, or could be perceived.
Are you employed by, a director for, or a member of an advisory board or special interest group, for any WSAVA Industry Partner (sponsor).
Are you assisting in the design of clinical studies concerning the use of products manufactured by a WSAVA Industry Partner (sponsor)?
Do you hold investments in an organisation that is a WSAVA Industry Partner (sponsor)?
By select yes below, I hereby certify that the information given above is true and complete to the best of my knowledge, and that I have read and agree to abide by the WSAVA Conflict of Interest Policy. You can view the conflict of interest policy in the WSAVA Policy and Process Manual: https://tinyurl.com/wsavamanual
YES
Date
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Month
-
Day
Year
Date
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