Continuing Pharmacy Education Application Sponsorship and Conflict of Interest

Having an interest in or an affiliation with a commercial interest does not prevent a speaker from making a presentation, but the relationship must be made known to the audience in accordance with the standards of the Accreditation Council for Continuing Pharmaceutical Education (ACPE). In order to fulfill this obligation, please complete the following information regarding relationships held within the past 12 months (this includes spouse/life partner affiliations as well).

Asterisk (*) indicates a required field.

Contact Information
Types of Relevant Financial Relationships

A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Please check all types of relationships that apply and provide the name of the commercial interest.

Off-Label Drug Use Disclosure

If any unapproved or off-label uses of products will be discussed, disclosure must be made to the participants regarding the unapproved or off-label use.

List products discussed as off-label usage