PSMMC Immunotherapy and Targeted Anti-Cancer Treatments Conference

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Expert Type

Name

First NameMiddle NameLast Name

Designation (Title will be displayed on event agenda)

Mobile Number

Country CodeArea CodePhone Number

Email

example@example.com

Specialty

Sub-specialty

Grade

Gender

Institution

Qualification/s - Place and Date

Special Certificates - Place and Date

No. of International Presentation

SCFHS No. or Medical License Number for International Speakers

License Expiry Date

Date

Identification No. (Saudi ID/Iqama)

Passport For non-Saudi

Date of Birth

Date

Nationality

Country of Residence

City

Short Bio, and the last 3 years of experience

File Upload (Upload CV)

Photo Upload

Prince Sultan Military Medical City
Academic Affairs
Continuous professional development department
Health Development Department

Disclosure of Conflict of Interest and Commercial Support
Commitment

In accordance with the standards set by the Saudi Commission for Health
Specialties (SCFHS) for accrediting providers of professional development
services, it is required to disclose any actual or potential conflicts of
interest and commercial support related to the scientific content of
activities and programs offered, as well as how any conflicts of interest, if
identified, will be addressed.

I hereby commit to disclosing any conflicts of interest or
commercial support, if applicable, in the professional development
activities and programs provided by Prince Sultan Military Medical City. I
further ensure that the scientific program remains independent of any
commercial interests. Additionally, I confirm that I have read, understood,
and documented the following:

• Identifying and disclosing any financial relationships related to commercial support for professional development activities and programs to participants in these activities and programs.

• Ensuring that educational activities and programs remain independent of any
interference, control, or inclusion of commercial interests, in accordance with the
SCFHS definitions of commercial interest and conflict of interest.

Date

Signature

Expert Data Form