Conflict of Interest disclosure form by representative speakers or investigators
Resources of research
expense
□contract □contribution □company
□scientific research fund □other （
Name of declarer
(lead presenter)
employee of company and/or profit-making organization
□
adviser of company and/or profit-making company
□
profit of stock
□
lecturer fees
□
manuscript fees
□
contributions
□
research expenses
□
fees of testimony, judgment, comment, etc.
□
others
□
Name of principal
investigator
employee of company and/or profit-making organization
□
adviser of company and/or profit-making company
□
profit of stock
□
lecturer fees
□
manuscript fees
□
contributions
□
research expenses
□
others
If yes, please specify the name of company and/or organization, your status.
Institution or
company/position
No
judgment, comment, etc.
Supplier of financial
resources
Institution or
company/position
No
fees of testimony,
）
□
□
If yes, please specify the name of company and/or organization, your status.

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