IsthInternational Society on

Thrombosis and Haemostasis

Please indicate below whether a potential conflict of interest exists for your presentation:

i?:!\ I declare that I do not have any affiliation with, or financial interest in a commercialI~anization posing a conflict of interest with my presentation.

o I have an affliation with or financial interest, which may be, perceived as posing apotential conflight of interest with my presentation. (Please, indicate belowcompany names and relationships, e.g. shareholder, speakers' bureau, research,support, etc.)

o I intend to talk about unlabeled usees) of the following commercial products:

Name (First, Last):

Christian GACHET

Signature' ~ Date Z£ {M !2oI2,~TABLISSEMENT FRANÇAIS DU SANG - ALSACE

Docteur Christian GACHET'0 rue Spielmann - BP36

67065 STRASBOURG CEDEX

IWInternationat Society on

Th*mbosis end Haem*stnsis

Please indicate below whether a potential conflrct of interest exists for your presentation:

n I declare that I do not have any affiliation with, or financial interest in a commercialorganization posing a conflict of interest with my presentation.

X I have an affliation with or financial interest, which may be, perceived as posing apotential conflight of interest with my presentation. (Please, indicate below companynames and relationships, e.g. shareholder, speakers'bureau, research, support, etc.J

speaker honoraria from Bayer, Boerhinger Ingelheim, Pfizer,Daiichi-

Sankyo

I I intend to talk about unlabeled use[sJ of the following commercial products:

Name (First, LastJ:

Sabine Eichinger "