CPD Financial Disclosure – Appendix C

  • It is policy of ACHENA to ensure balance, independence, objectivity and full transparency in all CPD activities. All those involved in developing content or offering presentations must complete this form.

  • Note: This is used to pair this form submission to a master Course Approval Application submission, so please make sure the course name entered here is correct
  • check all that apply
  • Disclosure

  • If NO, skip to DECLARATION section below. If YES, please check the boxes below that indicate how you will ensure full transparency of your financial interests and benefits.

  • Commercial Interest (Name of Company)Nature of Relevant Financial Relationship 
  • Resolution of Conflict of Interest

  • Declaration

    By typing your name below and submitting this form, you agree to the following: You will uphold academic standards to ensure balance, independence, and full transparency in my role in the development or presentation of this CPD activity. You agree to disclose all financial relationships and also agree to disclose if you do not have any financial relationships.