Declaration of Interests

This information will not be published, but will be held on file in the BAP office.

Please complete the following (must be completed for each abstract submission):

Your Details

A first name is required.* required

A last name is required.* required

An email address is required.Invalid email format.* required

A phone number is required.* required

Primary Employment is required.* required

1. Do you have patent/s or invention/s from which you may derive personal benefit in the area of psychopharmacology?
Yes No

2. Do you have ownership or part ownership of a company with interests in the area of psychopharmacology? (This would include holding the shares of major companies in one’s own name, or those of dependent family members.)
Yes No

3. Do you accept a personal retainer from any company with an interest in psychopharmacology?
Yes No

4. Do you act as a consultant to any company with an interest in psychopharmacology?
Yes No

5. Do you act or have you acted as an expert witness, either friendly or hostile to any company with an interest in psychopharmacology?
Yes No

6. Do you hold or have you held a research grant from any company with an interest in psychopharmacology?
Yes No

7. Do you hold membership of the speakers’ bureau for any company?
Yes No

8. Do you accept paid speaking engagements in industry supported symposia?
Yes No

9. Do you accept travel or hospitality NOT related to a speaking engagement?
Yes No

10. Do you receive any payments directly or indirectly from a pharmaceutical company as a result of recruiting patients into a research study related to psychopharmacology?
Yes No

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