Conflict of Interest Form

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CPD Providers:

The CFPC requires all presenters and members of Planning Committees to complete the CFPC Mainpro Declaration of Conflict of Interest form as part of the Mainpro application process.

A Conflict of Interest may occur in situations where the personal and professional interests of individuals may have actual, potential or apparent influence over their judgment and actions.

What kind of relationships should be disclosed? (Please note that examples are not limited to the following.)

  • Any direct financial interest in a commercial entity such as a pharmaceutical organization, medical devices company or communications firm (“the Organization”).
  • Investments held in the Organization.
  • Membership on the Organization’s Advisory Board or similar committee.
  • Current or recent participation in a clinical trial sponsored by the Organization.
  • Member of a Speakers Bureau.
  • Holding a patent for a product referred to in the CME/CPD activity of that is marketed by a commercial organization.

Failure to disclose or false disclosure may require the Planning Committee to replace the presenter/speaker.

Planning Committee (Effective June 1, 2012): Completed form for each planning committee member MUST be submitted at the time of application for accreditation (please scan and upload all forms as a single file on QuickConnect).

Presenter: These forms DO NOT need to be submitted to the CFPC at the time of application for accreditation and/or ethical review. Completed form for each presenter/speaker is required and must be retained by the CME/CPD organizer or provider.

To obtain a copy of the Declaration of Conflict of Interest form, please click here.

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