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CAGP-CCSMH 2022 Speaker & Planning Committee Agreement Form

  • 14 Oct 2022
  • 15 Oct 2022
  • Montreal, QC



This form is collecting the following: 

  1. Conflict of Interest Declaration for Accreditation 
  2. CFPC Disclosure Slide(For speakers: first fill out your CFPC disclosure slide before completing the electronic conflict-of-interest (COI) form.
  3. 2-3 sentence speaker bio for introductory purposes. 
  4. Speaker headshot (Headshots may be used for ASM promotion and are not mandatory)
  5. Speaker Release for Video and Audio Recording

Click REGISTER in the left-hand column once you are ready to complete your form.

The Royal College and College of Family Physicians of Canada (CFPC) require compliance with the National Standard for Support of Accredited CPD Activities (the National Standard), which describes the process and requirements for gathering, managing, and disclosing conflicts of interest (COI) to participants.

The Royal College Maintenance of Certification (MOC) and CFPC Mainpro+ COI forms have been merged for your convenience.


Conflict of interest: A COI is a set of conditions in which judgement or decisions concerning a primary interest (e.g., patient welfare, validity of research, quality of medical education) are unduly influenced by a secondary interest (personal or organizational benefit including financial gain, academic or career advancement, or other benefits to family, friends, or colleagues).

Perceived conflict of interest: A perceived COI is the appearance of a COI as judged by outside observers regardless of whether an actual conflict of interest exists

Real conflict of interest: A real COI is when two or more interests are indisputably in conflict.

National Standard Element 3: Conflict of Interest

This element describes the processes and requirements for gathering, managing and disclosing conflicts of interest to participants.

3.1 All members of the scientific planning committee (SPC), speakers, moderators, facilitators and authors must provide to the CPD provider organization a written description of all relationships with for-profit and not-for-profit organizations over the previous 2 years including (but not necessarily limited to):

  • Any direct financial payments including receipt of honoraria;
  • Membership on advisory boards or speakers’ bureaus;
  • Funded grants or clinical trials;
  • Patents on a drug, product or device; and
  • All other investments or relationships that could be seen by a reasonable, well informed participant as having the potential to influence the content of the educational activity.

3.2 The SPC is responsible to review all disclosed financial relationships of speakers, moderators, facilitators and authors in advance of the CPD activity to determine whether action is required to manage potential or real conflicts of interest. The SPC must also have procedures in place to be followed if a conflict of interest comes to its attention prior to or during the CPD activity.

3.3 All members of the SPC, speakers, moderators, facilitators, and authors, must disclose to participants their relationships as described in 3.1.

3.4 Any individual who fails to disclose their relationships as described in 3.1 and 3.3 cannot participate as a member of the SPC, speaker, moderator, facilitator or author of an accredited CPD activity.

COI Disclosure Process

1. All scientific planning committee members, speakers, moderators, facilitators, and authors must complete the Declaration of Conflict of Interest form.

2. All completed forms will be retained by the CPD organizer for a period of at least one year for auditing purposes.

3. A disclosure must be made to the audience regarding whether you do or do not have a relationship to disclose.

4. Speakers must disclose conflicts verbally and in writing using the CFPC COI slide template at the beginning of a presentation. If slides will not be used disclosures must be included in written program materials (e.g. conference program, course website, workbook, reading material) as applicable.

5. Speakers, moderators, facilitators, and authors are responsible for ensuring that their presentations, and education materials—and any recommendations—are balanced and reflect the current scientific literature. The only caveat to this guideline is where there is only one treatment or management strategy. Unapproved use of products or services must be declared in the presentation.

6. Any individual who fails to disclose their relationship(s) as required cannot participate as a member of the scientific planning committee, speaker, moderator, facilitator, or author of a Mainpro+ certified activity. 

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