Disclosure Information Name of Meeting Name of

Example
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:
Honoraria(manuscript fee) from:
Grant/Research funding from: YYY Corporation
Other remuneration from: WWW Corporation
- or -
I have no financial relationships to disclose.

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