Confidentiality and Conflict of Interest Policies and Form

This form is to be completed by:
All Board, committee and task force members, as well as employees, agents, independent contractors and consultants.
First Name *
Last Name *
Email *
List Position(s) *List all Board, committee and task force positions, as well as employees, agents, independent contractors and consultants.	500 of 500 characters remaining
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I have read, understand, and agree to abide by the FGNA Confidentiality and Conflict of Interest Policies above.
Agreement *	Yes No
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Are you involved in any activities or situations that might create or appear to create a conflict of interest?
Agreement: *	Yes No
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Describe all activities or situations you are involved in that might create or appear to create a conflict of interest, or respond “none”.
Answer *
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Please complete a new form if this information changes. Type your full name here to serve as your electronic signature:
Signature: *

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