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Disclosure Statement of Financial Interest

Grant/Research Support Consulting Fees/Honoraria Major Stock Shareholder/Equity Royalty Income Ownership/Founder Intellectual Property Rights Other Financial Benefit. Company One Company Two Company Three Company Four Company Five Company Six Company Seven.

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Disclosure Statement of Financial Interest

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  1. Grant/Research Support Consulting Fees/Honoraria Major Stock Shareholder/Equity Royalty Income Ownership/Founder Intellectual Property Rights Other Financial Benefit Company One Company Two Company Three Company Four Company Five Company Six Company Seven Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the company/ companies listed below that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Affiliation/Financial Relationship Company

  2. Disclosure Statement of Financial Interest I, (insert name) DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

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