SFDS Conflict of Interest Acknowledgement and Disclosure Form

Do you receive compensation as an officer, director, committee member, or task-force member of SFDS?
Other than reimbursement of reasonable expenses, have you received, or do you expect to receive, more than $10,000 per year from SFDS for services provided as an independent contractor?
Have you received, or do you expect to receive any material financial benefit from SFDS in addition, or apart from the benefits described in the above inquiries?
Does any family member receive compensation or material financial benefit from SFDS?
Do you have a family relationship or business relationship with any current officer, director, or key employee of SFDS? *1
I understand the Organization is tax-exempt and to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes.
I understand that board and committee members’ powers are invested for the good of all members of the organization rather than for personal benefit.
I agree to preserve the confidentiality of any information that comes into my possession or that is designated or treated as confidential by the association.
I agree to be particularly careful to not disclose legal information that come to the association through inside or outside legal counsel.
Yes

Electronic Signature

*1 This question does not apply to attorney-client or doctor-patient relationships, nor does it apply to relationships with clergy members.