Disclosure Statement of Conflict of Interest (COI) at the 56th Annual Meeting of the Japanese Society of Neurology To Executive President, Japanese Society of Neurology Name of declarer: Company/organization (institution, class/medical department) / Job title: Category of the lecture title registered lecture □Symposium □Educational topics seminar □Hot □Luncheon (Tick the applicable box) Lecture title: If there is any company with which the lead presenter has a conflict of interest (Declare any conflict of interest that required to be disclosed in connection existed within the one-year period with the subject of the lecture to be given, prior to the registration of the state the relevant facts in the following abstract) respective items. Relevant If yes, state the name of such Item party company or organization (1) Does the declarer/relative serve or (Declarer) has the declarer/relative served as No director or advisor of a company or for-profit organization? If yes, state the value of the remuneration (Relative) received for a period of one year. (State any compensation of 1 million JPY or more No received within a period of one year from one company or organization) (2) Does the declarer/relative hold or (Declarer) has the declarer/relative held any No shares in the company concerned? If yes, state the profit earned from such shares. (State any profit of 1 million JPY or more earned within a (Relative) period of one year from shares in one single company and any profit earned within a period of No one year from shares in one single company in the event of 5% or more of the company's shares being held by the declarer/relative) (3) Has the declarer/relative received (Declarer) any remuneration from a company or No for-profit organization as the fee for the use of a patent? (Relative) (State any annual remuneration of 1 million JPY or more received within a period of one year as the No fee for the use of one single patent)
Disclosure Statement of Conflict of Interest (COI) at the 56th Annual Meeting of the Japanese Society of Neurology To Executive President, Japanese Society of Neurology Name of declarer: Company/organization (institution, class/medical department) / Job title: Category of the lecture title registered □Symposium □Educational lecture □Hot topics □Luncheon seminar (Tick the applicable box) Lecture title: If there is any company with which the lead presenter has a conflict of interest required to be disclosed in connection with the subject of the lecture to be given, state the relevant facts in the following respective items. (Declare any conflict of interest that existed within the one-year period prior to the registration of the abstract) Item Relevant party If yes, state the name of such company or organization (1) Does the declarer/relative serve or has the declarer/relative served as director or advisor of a company or for-profit organization? If yes, state the value of the remuneration received for a period of one year. (State any compensation of 1 million JPY or more received within a period of one year from one company or organization) (Declarer) No (Relative) No (2) Does the declarer/relative hold or has the declarer/relative held any shares in the company concerned? If yes, state the profit earned from such shares. (State any profit of 1 million JPY or more earned within a period of one year from shares in one single company and any profit earned within a period of one year from shares in one single company in the event of 5% or more of the company's shares being held by the declarer/relative) (Declarer) No (Relative) No (3) Has the declarer/relative received any remuneration from a company or for-profit organization as the fee for the use of a patent? (State any annual remuneration of 1 million JPY or more received within a period of one year as the fee for the use of one single patent) (Declarer) No (Relative) No
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