Conflict of Interest Disclosure Form
This form is to be completed by all journalists and contributors submitting material for publication. Please declare any actual or potential conflicts of interest relevant to your submission.
1. Personal Information
Full Name
Email Address
Affiliation/Organization
2. Submission Details
Title of Submission
Brief Description or Subject Area
3. Disclosure of Conflict of Interest
a. Financial Interests
b. Personal Relationships
c. Other Potential Conflicts
4. Declaration
I declare that the information provided above is complete and accurate to the best of my knowledge.
Date