BTOG Trustees and Steering Committee Conflict of Interest and Code of Conduct Declaration Form "*" indicates required fields Name* First Last Email* Enter Email Confirm Email Declaration of Conflict of InterestBTOG Conflict of Interest Policy is available here. A conflict of interest may mean financial, investment, licensing or other commercial interest in the subject matter under discussion or under review. The reportable time period in all cases is within 2 years of the event date or review date. Employment or leadership (FT, PT, service as officer or board members) Advisory role Stock ownership Honoraria for speech, presentation or appearance Sponsorship Research funding – relating to clinical research being discussed Expert testimony Other remuneration including trips, travel, gifts, in-kind payments (excluding research related costs) DownloadSelect one option* I wish to make a conflict of interest declaration. I confirm I have no conflicts of interest to declare. Please list all conflicts of interest.BTOG views funding from tobacco and related industries as against BTOG’s aims and objectives.Select one option* I do not have a relationship with any tobacco or related industries. I do have a relationship with tobacco or related industries. Please list details of your relationship with tobacco or related industries.Use of Image/BiographyAV permission I give permission for the use of my image and biography on the BTOG website and in BTOG materials or advertisements. Declaration*In relation to suspensions, restrictions on practice or being subject to an investigation of any kind since my last declaration:Select one option* I do not have something to declare. I do have something to declare. Brief details below if something to declare.Declarations: Conflict of Interest - I declare that the conflict of interest details included on this form are true and accurate. I confirm I have read and agree to abide by the expectations/requirements within the policy relevant to my role within BTOG (e.g. Trustee Terms of Reference, Steering Committee Role Description and Code of Conduct). Probity - I declare that I accept the professional obligations placed on me by my own professional standards or code of conduct (e.g. GMC Good Medical Practice, NMC Code) in relation to probity. Health – I declare that I accept the professional obligations placed on me by my own professional standards or code of conduct (e.g. GMC Good Medical Practice, NMC Code) in relation to my personal health. For advocates who may not have professional standards - I declare that I will act with integrity, impartiality and honesty and will be fair and respectful as a committee member of BTOG. In relation to my personal health I will inform BTOG if I am unable to fulfil my role within BTOG or need any reasonable adjustments to be made to assist in this respect. Code of Conduct for Trustees and Steering Committee 2024 Download Declaration* I understand that checking this box serves as an electronic signature for the purposes of this form and all its contents. I declare that the details included on this form are true and accurate. Date*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
