Board Member Conflict of Interest Disclosure Form
Personal Information
Full Name
Board Position
Email Address
Phone Number
Disclosure of Interests
List any organizations, associations, or businesses in which you, your immediate family, or a business partner have a financial interest or hold a leadership role:
Describe any relationships, positions, or circumstances that may give rise to a conflict of interest:
Additional Relevant Information
Please provide any other information you feel is relevant:
I certify that the information contained in this form is true and complete to the best of my knowledge. I agree to update this disclosure as necessary and comply with the organization’s conflict of interest policy.
Signature
Date