Conflict of Interest Disclosure Statement The following items are activities or areas in which members of my immediate family or I might possibly have a conflict of interest in relation to my Council position. Any interests in which the member might hold, directly or indirectly, a position or a financial interest in any outside concern from which the individual has reason to believe the Council secures goods or services or that provides services competitive with the Council. Any situation in which the member competes, directly or indirectly, with the Council in the purchase or sale of property or property rights, interests, or services. Outside InterestsAny interests in which the member might hold, directly or indirectly, a position or a financial interest in any outside concern from which the individual has reason to believe the Council secures goods or services or that provides services competitive with the Council. Any situation in which the member competes, directly or indirectly, with the Council in the purchase or sale of property or property rights, interests, or services.Describe if Outside Interests checked:Any situation whereby the member renders directive, managerial, or consultative services to any outside concern that does business with, or competes with the services of the Council, or to render other services in competition with the Council. Outside ActivitiesAny situation whereby the member renders directive, managerial, or consultative services to any outside concern that does business with, or competes with the services of the Council, or to render other services in competition with the Council.Describe if Outside Activities checkedAny acceptance of gifts, entertainment, or other favors from any outside concern that does, or is seeking to do business with, or is a competitor of the Council. Gifts, Gratuities and EntertainmentAny acceptance of gifts, entertainment, or other favors from any outside concern that does, or is seeking to do business with, or is a competitor of the Council.Describe if Gifts, Gratuities and Entertainment checked:Any situation whereby knowledge of the Council and its business could be used for the personal profit or advantage of the individual or his/her immediate family. Inside InformationAny situation whereby knowledge of the Council and its business could be used for the personal profit or advantage of the individual or his/her immediate family.Describe if Inside Information checked: I have no conflict(s) of interest of which I am presently aware but will notify the Executive Director of the Council or the Chair of the Council immediately if/when one occurs.Annual Statements:As a Council member and/or member of a committee with Council-delegated powers, I affirm that: I have received a copy of the conflict of interest policy. I have read and understand the conflict of interest policy. I agree to comply with the conflict of interest policy. I certify that all information provided as part of this statement is true and correct to the best of my knowledge.By selecting the "I Accept" button, I am signing this Statement electronically.* I AcceptDate MM slash DD slash YYYY Name* First Last Signature*
