Conflict Of Interest Disclosure Form
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1Conflict of Interest Disclosure Form
Name: _______________________
Date: ________________________
Please describe below any relationships, positions or circumstances in which you are
involved that you believe could contribute to a potential Conflict of Interest.
I hereby certify that the information set forth above is true and complete to the best of my
knowledge. I have reviewed, and agree to abide by, the Conflict of Interest Policy of
Assistance League of Norman that is currently in effect.
Signature: _____________________
Date: _________________________
Reviewed and Recommended by Bylaws Committee:
January 15, 2013
Board Approved: January 24, 2013
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