You must read the information provided and answer the questions regarding your financial relationships with ineligible companies to participate in this activity. Activity Role * Planner Teacher, Instructor, Faculty Author, Writer Reviewer Other... Activity Role Other... In the past 24 months, I have not had any financial relationships with any ineligible companies * True False Enter the Name of Ineligible Company * Enter the Nature of the Financial Relationship * Has the Relationship Ended? * Yes No Do you have any additional financial relationships? * If you have more than one ineligible company, please answer "yes" to this question. Yes No Enter the Name of Ineligible Company * Enter the Nature of the Financial Relationship * Has the Relationship Ended? * Yes No Do you have any additional financial relationships? * If you have more than one ineligible company, please answer "yes" to this question. Yes No Enter the Name of Ineligible Company * Enter the Nature of the Financial Relationship * Has the Relationship Ended? * Yes No Do you have any additional financial relationships? * If you have more than one ineligible company, please answer "yes" to this question. Yes No Leave this field blank
