Conflict of Interest Disclosure Form
For Non-Profit Organizations
Name
Position/Title
Email Address
Affiliated Organization (if any)
Please disclose any personal, professional, or financial relationships, affiliations, or interests that may represent a conflict of interest with your service to this organization:
Other Potential Conflicts (if any):
By signing below, I declare to the best of my knowledge that the information provided above is true and complete. I agree to promptly update this disclosure if my circumstances change.
Signature
Date