Disclosure Information Name of Meeting Name of

Example
The Japanese Society of Pediatric Hematology and Oncology
COI Disclosure Information
Name of the Speaker
I have the following financial relationships to disclose.
Leadership position/advisory role for: XXXX, Inc.
Stockholder in: YYY Corporation, ZZZ Corporation
Patents and royalties from: YYY Corporation
Honoraria(lecture fee) from: None
Honoraria(manuscript fee) from: None
Grant/Research funding from: YYY Corporation
Other remuneration from: WWW Corporation
Employee of: ZZZ Corporation
Example
The Japanese Society of Pediatric Hematology and Oncology
COI Disclosure Information
Name of the Speaker
I have no financial relationships to disclose.