Page 1 of 2

Disclosure of Conflict of Interest (COI) - CSPM 2026

CSPM requires annual Conflict of Interest (COI) disclosures from all Board and Committee members under our approved COI Policy. This upholds transparency and good governance to ensure unbiased decision-making.

Definitions:

Conflict of interest: A conflict of interest is a set of conditions in which judgment or decisions concerning a primary interest (example a patients’ welfare, the validity of research and/or quality of medical education) is unduly influenced by a secondary interest (personal or organizational benefit including financial gain, academic or career advancement, or other benefits to family, friends, or colleagues).
Perceived conflict of interest: A perceived conflict of interest is the appearance of a conflict of interest as judged by outside observers, regardless of whether an actual conflict of interest exists
Real conflict of interest: A real conflict of interest is when two or more interests are indisputably in conflict.

Your personal details


Which Committees (or Board) are you a member of?

Which Committees (or Board) are you a member of?

Please indicate whether you have relationships with for-profit or not-for-profit organizations to disclose (over the previous two years).

Please indicate whether you have relationships with for-profit or not-for-profit organizations to disclose (over the previous two years).
A
B

If you have relationships to disclose, please complete the relevant sections below.

For each category, list the name(s) of the organization(s) and briefly describe the relationship.

Any direct financial payments including receipt of honoraria

Membership on advisory boards or speakers’ bureaus

Funded grants or clinical trials

Patents on a drug, product or device

All other investments or relationships that could be seen by a reasonable, well- informed participant as having the potential to influence the content of the educational activity


Please upload your high-resolution headshot, if you haven't already sent it to the CSPM Executive Office:


Date

Please sign here:

Signature

By clicking “I agree” you are acknowledging that the above information is accurate and that you understand that this information will be publicly available.

By clicking “I agree” you are acknowledging that the above information is accurate and that you understand that this information will be publicly available.