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CME/CE Activity: *

Society of University Neurosurgeons

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Within the past 24 months, have you had any financial relationships with any ACCME-defined ineligible companies? *

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Has the relationship ended?

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Has the relationship ended?

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Has the relationship ended?

Yes

No

Has the relationship ended?

Yes

No

Has the relationship ended?

Yes

No

Has the relationship ended?

Yes

No

Has the relationship ended?

Yes

No

My signature (or typed name below indicates that I have read and completed this form myself and to the best of my ability provided current and accurate information as of this date of submission *

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