Instructor Financial Disclosure
Please identify any direct financial or proprietary interests you may have in any of the companies, products, pharmaceuticals, or services you may have mentioned, or intend to mention in your presentation. You must also disclose if you provide for-profit support of any kind, are a paid consultant to, an employee of, or serve as an officer on the board of any companies mentioned in your presentation. If your course is approved for qualification, this information must be disclosed at the beginning of the presentation to your audience in a clear and unambiguous manner, both verbally and in your written course handout/outline.
Note: If you are submitting this course on behalf of the Course Instructor(s) you must attach the financial disclosure information for each instructor.
I have read and will comply with the COPE requirements for course qualification. I agree to notify COPE in writing if the financial/proprietary information disclosed above changes at any time during the three-year qualification period of this course.
Signature of Principal Instructor or Submitter: