ISCTM Conflict of Interest « ISCTM | The International Society for CNS Clinical Trials and Methodology

In the disclosure section, please enter all interests (including employment, consulting, or other financial interests) held by committee member or member’s family that could constitute a conflict from January 2022 to present. Once completed, please select 'submit' at bottom of page.

Last Name*

First Name*

Click here to View the COI Policy

I acknowledge that I have received a copy of the International Society for CNS Clinical Trials conflicts of interest policy; that I have read, understand and agree to comply with the policy.*

Yes

I understand the International Society for CNS Clinical Trials is a charitable organization and in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more of its tax-exempt purposes.*

Yes

Please select one. If you have more than 5 companies to report, please choose option 3 and email to Executive Director.*

I have nothing to report.
I have completed the below online disclosures.
I am emailing disclosures to Executive Director.

Company 1

Type of Support Company 1 (e.g., employee, grant, consulting fees)

Equity/Stockholder - Company 1

Yes
No

Company 2

Type of Support Company 2 (e.g., employee, grant, consulting fees)

Equity/Stockholder Company 2

Yes
No

Company 3

Type of Support Company 3 (e.g., employee, grant, consulting fees)

Equity/Stockholder Company 3

Yes
No

Company 4

Type of Support Company 4 (e.g., employee, grant, consulting fees)

Equity/Stockholder Company 4

Yes
No

Company 5

Type of Support Company 5 (e.g., employee, grant, consulting fees)

Equity/Stockholder Company 5

Yes
No

ISCTM Conflict of Interest

Acceptance and Disclosure Statement

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