CAPhO Conflict of Interest Disclosure Statement / Confidentiality Agreement for CAPhO Volunteers
Please complete all applicable questions in the Conflict of Interest Disclosure Statement and the Confidentiality Agreement. Once completed, click on the "Submit" button. 

When filling in the form, use Sentence Case (e.g. John Smith) instead of all CAPITAL letters (e.g. JOHN SMITH) or all small letters (ex. john smith). Fields followed by * are required information and need to be filled in before submitting. The text boxes will enlarge automatically depending on how much text you insert. If you are copying text from another document, please paste it as simple text (to remove any formatting) into the response fields.

Should you require assistance, please contact the Association Management Office at info@capho.org.
CAPhO's Conflict of Interest Policy
All CAPhO Board, Committee and Task Force members will declare annually and continually any real, potential or perceived conflicts of interest, including relationships they have with any entity that supports CAPhO activities, provides services to CAPhO, is seeking CAPhO business, or that may have an interest in influencing CAPhO programs or policies.

Any CAPhO Board, Committee and/or Task Force member aware of a real, potential or perceived conflict of interest shall declare such to the President or Chair of the Board, Committee/Task Force prior to entering into discussions or decisions that are or may be in conflict. 

CAPhO maintains a process for determining, based on a Board, Committee or Task Force member's declaration, if a real, potential or perceived conflict of interest exists and for ensuring that no Board, Committee or Task Force member is engaged in CAPhO program discussions or decisions for which he or she has a real, potential or perceived conflict of interest.
Disclosure Statement
Contact Details
CAPhO Committee(s) and/or Task Force(s)
1. A real, potential or perceived conflict with my involvement in this CAPhO Board of Directors, Committee and/or Task Force may arise because:
2. Describe the nature of the real, potential or perceived conflict between the CAPhO Board, Committee and/or Task Force and other office, committee, working group or possession of interests:
3. Other than the above disclosure(s), do you have any relationships or interests that could compromise, or be perceived to compromise, your ability to exercise judgment or decision making independently and objectively with a view to the best interests of this CAPhO Board, Committee and/or Task Force?
If yes, please describe:
The details I have provided in the Disclosure Statement are accurate to the best of my knowledge. If at any time following the signing of this Disclosure Statement, there occurs any changes to the information given herein regarding a conflict of interest, either by way of addition or deletion, I shall forthwith contact the Association Management Office at info@capho.org in order to update the Disclosure Statement.
Confidentiality Agreement
Any and all information, data and planning completed by CAPhO Board, Committees and Task Forces is considered confidential and should not be released to third parties.




CAPhO Association and Conference Management Office: Sea to Sky Meeting and Association Management Inc. 
Suite 206, 201 Bewicke Avenue, North Vancouver, BC, Canada  V7M 3M7 
T: +1-604-984-6455 * Email: info@capho.org * www.capho.org

Thank you for completing the Conflict of Interest / Confidentiality Statement for CAPhO Board, Committee and Task Force Members.

If you have any questions about the Disclosure Statement or need to make any changes to it once it has been submitted, please contact the Association Management Office at info@capho.org.

Canadian Association of Pharmacy in Oncology (CAPhO)
Association Management Office

c/o Sea to Sky Meeting and Association Management Inc.
Suite 206, 201 Bewicke AVenue
North Vancouver, BC V7M 3M7
Phone:  +1-604-984-6455
Email:  info@capho.org

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CAPhO Association and Conference Management Office: Sea to Sky Meeting and Association Management Inc. 
Suite 206, 201 Bewicke Avenue, North Vancouver, BC, Canada  V7M 3M7 
T: +1-604-984-6455 * Email: info@capho.org * www.capho.org

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