Disclosure Form Submission
Thank you for participating in our educational activity Richard Lende Conference January 28-31, 2022. We believe that education must be free from any commercial bias and to offer CME credit for your part of the activity, we must disclose any relevant financial relationships to learners. Please complete this short survey regarding your relevant financial relationships as soon as possible, but no later than January 7, 2022.
Submit form online.
By Mail or Email
If sending by mail or email, download the Disclosure Form [pdf] and send to address below.
Randy Jensen, MD, PhD
175 North Medical Drive East
Salt Lake City, Utah 84132-2303
Faculty Disclosure Listing
Those who have disclosed a relationship* with commercial interests are listed below:
|Name||Disclosure||Type of Relationship|
*Relationship refers to receipt of royalties, consultantship, funding by research grant, receiving
honoraria for educational services elsewhere, or any other relationship to a commercial interest
that provides sufficient reason for disclosure.
Those who have reported they do not have any relationships with commercial interests:
Randy L. Jensen, MD, PhD,
Professor - Department of Neurosurgery
William T. Couldwell, MD, PhD
Professor & Chair - Department of Neurosurgery
Lanette Dunbar Meeting Coordinator Health Science Center Bldg 550, 5th Floor 175 N. Medical Drive East Salt Lake City, UT 84132 Phone: 801-556-2539 Fax: 801-581-4385 Email: firstname.lastname@example.org