Conflict of Interest Disclosure Form

Full Name
Email Address
Manuscript Title
Manuscript ID (if applicable)

Potential Conflicts of Interest

1. Financial Interests
I have relevant financial interests to disclose.
2. Personal Relationships/Competing Interests
I have relevant personal relationships or competing interests.
3. Intellectual Property Interests
I have relevant intellectual property interests to disclose.

Other Potential Conflicts

Please describe any other potential conflicts of interest
Signature
Date