Conflict of Interest Form

Conflict of Interest Disclosure Form

The Conflict of Interest Policy of the Presbytery of Hudson River (HRP) requires an annual affirmation that you have received, read, understood and agreed to comply with the Conflict of Interest Policy. In addition, the Policy requires that you annually disclose:

your affiliations with any organization with which the Presbytery of Hudson River may have a relationship, financial or otherwise. and
any persons with whom you have a personal relationship (such as a family member or close companion), who are affiliated with any organization or professional society with which the Presbytery of Hudson River may have a relationship, financial or otherwise.

Please sign this Statement indicating your affirmation as described above. Please disclose, in addition, any applicable affiliations known to you.

Please return this Statement to the Stated Clerk of the Presbytery of Hudson River before your first meeting of every year.

*NOTE: At a minimum, your congregation (where you are a member or pastor) is a conflict of interest. Submitting the form without at least writing in your congregation is impossible.

Name

Position

Please describe below any relationships, transactions, positions you hold (volunteer or otherwise), or circumstances that you believe could contribute to a conflict of interest.

I have the following conflict of interest to report (please specify other non-profit and for-profit boards you (and your family) sit on; any for-profit businesses for which you or an immediate family member is an officer, director or majority shareholder; and the name of your employer and any businesses that you or a family member own:

If reporting conflict of interests please list them here:

TO BE COMPLETED BY EACH HRP-INVOLVED PERSON: I have read and understand the Conflict of Interest Policy and agree to comply.

I understand that my electronic signature counts as my legal signature.