Conference title
date
location
INVITED SPEAKERS and PLANNING COMMITTEE
CONFLICT OF INTEREST DISCLOSURE
Current ACCME (Accreditation Council for Continuing Medical Education) rules state that participants in CME
activities should be made aware of any affiliation or financial interest that may affect the planning of a
conference or a speaker's presentation(s). Each planning committee member and speaker has been requested
to complete a conflict of interest statement for the [insert name of conference], and those statements
follow:
The following planning committee members/speakers do not anticipate discussing unlabeled uses of any
commercial or investigational products in this educational activity:

John Doe, MD
The following planning committee members/speakers have disclosed that they have no relationship with any
commercial firm having products related to topics they will discuss at this educational activity:

John Doe, MD
The following planning committee members/speakers have disclosed the following Conflict of Interest:

John Doe, MD, is employed by…. Etc.
6/2009