Pelvic Health Summit Speaker Disclosure & Release
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Speaker Release

Please check the box next to each item below to acknowledge your acceptance.

Full Disclosure

It is the policy of Mountain Land Physical Therapy to ensure balance, independence, objectivity and scientific rigor in all programs it provides. Everyone in a position to control the content of an educational activity must disclose all relevant financial relationships with commercial interests. The information you provide addresses several requirements of the national accreditation boards (ACCME, ACPE, etc.) regarding independence from commercial interests. This information must be disclosed to participants prior to the beginning of the activity. Lastly, all conflicts of interest must be resolved prior to the educational activity. The ACCME defines "relevant" financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. (2.1) An individual who refuses to disclose relevant financial relationships will be disqualified from being a planning committee member, a teacher, or an author of CME, and cannot have control of, or responsibility for, the development, management, presentation or evaluation of the CME activity. (2.2)
Title of CME Activity: 2023 Mountain Land Pelvic Health Summit
Dates of CME Activity: May 4 - 6, 2023
In the past 12 months, have you (or spouse/partner) had a financial relationship with a commercial organization that produces, markets, re-sells, or distributes health care goods or services consumed by, or used on patients, and which is relevant to the content of this educational activity?
If yes, please list the name and your role with the commercial interest, manufacturer or service provider for each of the following affiliation/financial interests: