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Registration number: ____________________________

The authors agree to assign to the Korean Journal of Helicobacter and Upper Gastrointestinal Research in any form, including internet distribution, when the literature is published.

Potential conflicts of interest related to the content of this study must be disclosed regarding financial interest, patent or stock ownership, relationship, consultancy, receipt of speaker's fees, or any benefits from a commercial party. If there is no conflict of interest, write “None” under “Name.”

Date: ____________________________

Title of manuscript: ________________________________________________________


Authors' signature
(Write the names of all authors in Korean and English with their respective signatures)

  Korean Name   English Name   Sign
Name (1)
Conflict of interest:
Name (2)
Conflict of interest:
Name (3)
Conflict of interest:
Name (4)
Conflict of interest:
Name (5)
Conflict of interest:
Name (6)
Conflict of interest:
Name (7)
Conflict of interest:

If there are more than seven co-authors, please make a copy of this form



Lotte Gold Rose II Room 917, 31 Seolleung-ro 86-gil, Gangnam-gu, Seoul 06193, Korea
Mailed to: The Editor-in-Chief, Korean Journal of Helicobacter and Upper Gastrointestinal Research
Fax: (02) 565-9947, E-mail: hpylori@kams.or.kr

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Lotte Gold Rose II Room 917, 31 Seolleung-ro 86-gil, Gangnam-gu, Seoul 06193, Korea
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