Presenter Full Disclosure Form CME Activities


The following form is for presentation at the First Global Summit for Restorative Reproductive Medicine being held virtually on February 19 2021.

Please complete the following form and provide any potential conflicts of interest (or the lack thereof) with regards to your webinar presentation, in accordance with the IIRRM's Policy and Procedures for Full Disclosure and Identification and Resolution of Conflicts of Interest.  Disclosure must be made to the audience indicating whether you have or have not had relationships with for‐profit or not‐for‐profit organizations within the past 2 years.  All disclosures should be stated at the beginning of your presentation to the audience, and included in the second slide of your presentation.

All speakers/faculty must also disclose to IIRRM and learners when an unlabeled use of a commercial product, or an investigational use not yet approved for any purpose, is discussed during an educational activity, or when a product is not labeled for the use under discussion or that the product is still investigational.   IIRRM encourages the exchange of views in scientific and educational discussions, including discussions of unapproved uses, but require faculty to inform the audience that such a discussion is taking place.  If you have any questions or concerns please don't hesitate to reach out to Kathleen at

For an explanaton and examples of devloping leanrng outcomes for CME please view this link:


IIRRM is a registered provider of continuing medical education (CME) through the American Academy of Family Physicians (AAFP) and the the EACCME (European Accreditation Council for Continuing Medical Education).   IIRRM ensures that material provided meets all requirements of the Standards and Guidelines set out by the ACCME Standards for Commercial Support, 

For information on creating learning objectives, along with example objectives can be downloaded here.

An example disclosure slide for declaring conflicts of interest can be downloaded here.  If you have nothing to disclose, another example slide can be downloaded here.