2025 Speaker Registration |

Title

First Name

Last Name

Degree

Additional Degree

Organization / Clinic

Professional Title

Additional Organization / Clinic

Additional Professional Title

Email

Confirm Email

Additional Email Address

Phone Number

Picture and Bio

Please upload a headshot and a short bio for use on the conference website, virtual platform, and other promotional materials. Your headshot should be a JPG or PNG file and include your head and shoulders.

Headshot

Click or drag files to this area to upload. You can upload up to 3 files.

Bio

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Learning Objectives

Please enter your learning objectives for your session in the text box below as we require this information in order to apply for CME credits for the Conference. Feel free to use the following link to develop the learning objectives: CanMED Learning Objectives

CanMED Learning Objectives

CanMED Roles

Please identify your CanMED Roles and provide them in the text box below.

CanMED Roles

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Disclosure of Potential Conflict of Interest

The BC Pediatric Society requires all presenters and members of planning committees to complete this Disclosure of Potential Conflict of Interest form. The Canadian Medical Association Policy, “Physicians and the Pharmaceutical Industry (Update 2007)” indicates that, CME/CPD organizers and individual physician presenters are responsible for ensuring the scientific validity, objectivity and completeness of CME/CPD activities. Organizers and individual presenters must disclose to the participants at their CME/CPD events any financial affiliations with manufacturers of products mentioned at the event or with manufacturers of competing products. The intent of this policy is not to prohibit speakers from presenting, but rather to inform the audience of any possible bias that speakers may have.

Disclosure Policy

I have read and will adhere to the BCPS disclosure policy. I understand that failure or refusal to disclose within the established time frame will require the BCPS to identify a replacement. I will ensure balance, independence, objectivity and scientific rigor in my role in the presentation of my session. I will verbally disclose this information to the audience at the beginning of the presentation and include it on the 2nd slide of my presentation. Planning committee disclosures will be included in program materials.

Conflict of Interest

Neither I nor any member of my immediate family has a financial relationship or interest or any relationship as a member of an advisory board or similar committee (currently or within the past 24 months) with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
I have and/or an immediate family member has a financial relationship or interest or any relationship as a member of an advisory board or similar committee (currently or within the past 24 months) with an entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Objectives Commercial Bio

The financial relationships will need to be identified on the next page.

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Presentation Materials

Please feel free to upload any material such as your presentation slides, handouts, or links that you would like to share with attendees. You can come back anytime to update and upload your documents later.

Presentation Slides and Handouts

I grant permission to the BC Pediatric Society to share my presentation slides / handouts as a PDF in a secured area with members of the society and conference attendees.

Are the materials ready for upload?

Yes
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