CONFLICT OF INTEREST STATEMENT: 2017 For Officers, Directors, and Board Committee Members of the Pacific Council on International Policy: No member of the PACIFIC COUNCIL ON INTERNATIONAL POLICY (hereafter, “PACIFIC COUNCIL”) Board of Directors, or any of its Committees, shall derive any personal profit or gain, directly or indirectly, by reason of his or her participation with the PACIFIC COUNCIL. Each individual shall disclose to the PACIFIC COUNCIL any personal interest which he or she may have in any matter pending before the organization and shall refrain from participation in any decision on such matter. Any member of the PACIFIC COUNCIL’s Board of Directors who is an officer, board member, committee member or staff member of an organization that provides products or services to the PACIFIC COUNCIL shall identify his or her affiliation with such agency or agencies; further, he/she shall not participate in any decision directly to do with the provision of goods or services or contractual relations between provider and the PACIFIC COUNCIL and the decision must be made and/or ratified by the Board of Directors according to the bylaws of the organization. Any member of the PACIFIC COUNCIL Board shall refrain from obtaining any list of PACIFIC COUNCIL members for personal or private solicitation purposes at any time during the term of their affiliation At this time, I am a Board member, a committee member, or an employee of the following organizations: Affiliations Now this is to certify that I, except as described below, am not now nor at any time during the past year have been: 1. A participant, directly or indirectly, in any arrangement, agreement, investment, or other activity with any vendor, supplier, or other party; doing business with the PACIFIC COUNCIL which has resulted or could result in personal benefit to me. 2. A recipient, directly or indirectly, of any salary payments or loans or gifts of any kind or any free service or discounts or other fees from or on behalf of any person or organization engaged in any transaction with the PACIFIC COUNCIL. Any exceptions to 1 or 2 above are stated below with a full description of the transactions and of the interest, whether direct or indirect, which I have (or have had during the past year) in the persons or organizations having transactions with the PACIFIC COUNCIL. Exceptions Signature * Please type your First and Last Name Agreement * I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
