Declaration of Interest Form

Declaration of Interest form

• The British Oncology Pharmacy Association (BOPA) must maintain its integrity and reputation and therefore must ensure independence, objectivity and transparency in all its activities. Any conflict of interest must be declared at the earliest possible stage for any financial or other interest in any transaction, or proposed transaction, between BOPA and a third party.
• All individuals undertaking an activity on behalf of BOPA must complete a conflict of interest and self-declaration form. This includes, but is not limited to, working on BOPA Committees, representing BOPA on any project or speaking on behalf of the organisation.
• BOPA does not take any responsibility for conflicts of interest that may exist of any individuals and it is the sole responsibility of the individual to make a declaration

Please see here for BOPA Guidance on Declaration of Interest: https://www.bopa.org.uk/resources/bopa-guidance-on-declaration-of-interest-policy/

First name *

Last name *

BOPA committee(s) that you are a part of

Position within BOPA

Current Employer

Description of conflict of interest(s): Product/Group/Service

Nature of conflict of interest(s) (Shares, fees, consultancy, sponsorship, grant, honoraria etc)

Signature

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