Stacey Burgess, PhD

University of Virginia
115 Mimosa Dr.
APT#208
Charlottesville,VA, VA
United States 22903

Any personal financial relationships? No

I have disclosed to ICMI all relevant financial relationships, and hereby allow ICMI to disclose this information to learners in print.

1. I will insure balance, independence, objectivity, and scientific rigor in my role in the planning, development or presentation of this CME activity.

2. I will comply with the requirements to protect health information under the Health Insurance Portability & Accountability Act of 1996 (HIPAA).

3. I will disclose any discussion or reference to unapproved or unlabeled uses of therapeutic agents or products.

4. I have input my full name below as attestation of agreement with declaration statements. Marking the check box and indicating my name is in lieu of signature and is considered an "e-signature".

Signed on 02/04/2015 by Stacey Burgess

Papers:
W.89 Microbiota Mediated Protection from Entamoeba histolytica Infection

	I have disclosed to ICMI all relevant financial relationships, and hereby allow ICMI to disclose this information to learners in print.
	1. I will insure balance, independence, objectivity, and scientific rigor in my role in the planning, development or presentation of this CME activity.
	2. I will comply with the requirements to protect health information under the Health Insurance Portability & Accountability Act of 1996 (HIPAA).
	3. I will disclose any discussion or reference to unapproved or unlabeled uses of therapeutic agents or products.
	4. I have input my full name below as attestation of agreement with declaration statements. Marking the check box and indicating my name is in lieu of signature and is considered an "e-signature".