{"id":573,"date":"2014-08-24T15:46:06","date_gmt":"2014-08-24T15:46:06","guid":{"rendered":"https:\/\/www.avacon.org\/blog\/?page_id=573"},"modified":"2014-08-24T15:46:06","modified_gmt":"2014-08-24T15:46:06","slug":"annual-directors-conflict-of-interest-policy-form","status":"publish","type":"page","link":"https:\/\/www.avacon.org\/blog\/documents\/annual-directors-conflict-of-interest-policy-form\/","title":{"rendered":"Annual Directors Conflict of Interest Policy Form"},"content":{"rendered":"<h1>Annual Directors Conflict of Interest Policy Form<\/h1>\n<p>All members of the AvaCon Executive Board, Officers, and Directors are required to annually review the <a href=\"https:\/\/www.avacon.org\/blog\/documents\/conflict-of-interest-policy\/\" target=\"_blank\">AvaCon Conflict of Interest Policy<\/a> and complete the form below.<\/p>\n<p>&nbsp;<\/p>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_25_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form \" id=\"form_abb40j\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"25\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_25\" id=\"frm_hide_fields_25\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"abb40j\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_25\" name=\"frm_submit_entry_25\" value=\"797c600ece\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/blog\/wp-json\/wp\/v2\/pages\/573\" \/><div id=\"frm_field_664_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_pdt8jq\" class=\"frm_primary_label\">Full Legal Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_pdt8jq\" name=\"item_meta[664]\" value=\"\"  data-reqmsg=\"Full Legal Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Full Legal Name is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_665_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_x6vakr\" class=\"frm_primary_label\">Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_x6vakr\" name=\"item_meta[665]\" value=\"\"  style=\"width:90px\" maxlength=\"10\" data-reqmsg=\"Date cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"auto_width\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_666_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Are you a Voting Director?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_666-0\">\t\t\t<label  for=\"field_1im2hy-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[666]\" id=\"field_1im2hy-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Are you a Voting Director? cannot be blank.\" data-invmsg=\"Are you a Voting Director? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_666-1\">\t\t\t<label  for=\"field_1im2hy-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[666]\" id=\"field_1im2hy-1\" value=\"No\"\n\t\t data-reqmsg=\"Are you a Voting Director? cannot be blank.\" data-invmsg=\"Are you a Voting Director? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_667_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Are you an Officer?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_667-0\">\t\t\t<label  for=\"field_kcj7z4-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[667]\" id=\"field_kcj7z4-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Are you an Officer? cannot be blank.\" data-invmsg=\"Are you an Officer? is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_667-1\">\t\t\t<label  for=\"field_kcj7z4-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[667]\" id=\"field_kcj7z4-1\" value=\"No\"\n\t\t data-reqmsg=\"Are you an Officer? cannot be blank.\" data-invmsg=\"Are you an Officer? is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_668_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">If you are an Officer, what position do you hold?\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_668-0\">\t\t\t<label  for=\"field_p3psy-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[668]\" id=\"field_p3psy-0\" value=\"President\"\n\t\t data-invmsg=\"If you are an Officer, what position do you hold? is invalid\"   \/> President<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_668-1\">\t\t\t<label  for=\"field_p3psy-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[668]\" id=\"field_p3psy-1\" value=\"Vice President\"\n\t\t data-invmsg=\"If you are an Officer, what position do you hold? is invalid\"   \/> Vice President<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_668-2\">\t\t\t<label  for=\"field_p3psy-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[668]\" id=\"field_p3psy-2\" value=\"Treasurer\"\n\t\t data-invmsg=\"If you are an Officer, what position do you hold? is invalid\"   \/> Treasurer<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_668-3\">\t\t\t<label  for=\"field_p3psy-3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[668]\" id=\"field_p3psy-3\" value=\"Clerk\"\n\t\t data-invmsg=\"If you are an Officer, what position do you hold? is invalid\"   \/> Clerk<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_669_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Received Policy\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_669-0\">\t\t\t<label  for=\"field_vukhsw-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[669]\" id=\"field_vukhsw-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Received Policy cannot be blank.\" data-invmsg=\"Received Policy is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_669-1\">\t\t\t<label  for=\"field_vukhsw-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[669]\" id=\"field_vukhsw-1\" value=\"No\"\n\t\t data-reqmsg=\"Received Policy cannot be blank.\" data-invmsg=\"Received Policy is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div id=\"frm_desc_field_vukhsw\" class=\"frm_description\">I affirm that I have received a copy of the AvaCon, Inc. Annual Directors Conflict of Interest Policy.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_670_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Read & Understand Policy\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_670-0\">\t\t\t<label  for=\"field_et4dst-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[670]\" id=\"field_et4dst-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Read &amp; Understand Policy cannot be blank.\" data-invmsg=\"Read &amp; Understand Policy is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_670-1\">\t\t\t<label  for=\"field_et4dst-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[670]\" id=\"field_et4dst-1\" value=\"No\"\n\t\t data-reqmsg=\"Read &amp; Understand Policy cannot be blank.\" data-invmsg=\"Read &amp; Understand Policy is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div id=\"frm_desc_field_et4dst\" class=\"frm_description\">I affirm that I have read and understand the AvaCon, Inc. Annual Directors Conflict of Interest Policy.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_671_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Agree to Comply\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_671-0\">\t\t\t<label  for=\"field_9lngsx-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[671]\" id=\"field_9lngsx-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Agree to Comply cannot be blank.\" data-invmsg=\"Agree to Comply is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_671-1\">\t\t\t<label  for=\"field_9lngsx-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[671]\" id=\"field_9lngsx-1\" value=\"No\"\n\t\t data-reqmsg=\"Agree to Comply cannot be blank.\" data-invmsg=\"Agree to Comply is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div id=\"frm_desc_field_9lngsx\" class=\"frm_description\">I affirm that I agree to comply with the AvaCon, Inc. Annual Directors Conflict of Interest Policy.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_672_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Charitable Organization\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_672-0\">\t\t\t<label  for=\"field_dubbcx-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[672]\" id=\"field_dubbcx-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Charitable Organization cannot be blank.\" data-invmsg=\"Charitable Organization is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_672-1\">\t\t\t<label  for=\"field_dubbcx-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[672]\" id=\"field_dubbcx-1\" value=\"No\"\n\t\t data-reqmsg=\"Charitable Organization cannot be blank.\" data-invmsg=\"Charitable Organization is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div id=\"frm_desc_field_dubbcx\" class=\"frm_description\">I affirm that I understand AvaCon, Inc. is a charitable organization and in order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more tax-exempt purposes.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_673_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Disclosures - Conflict of Interest\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_673-0\">\t\t\t<label  for=\"field_qvlp07-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[673]\" id=\"field_qvlp07-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Disclosures - Conflict of Interest cannot be blank.\" data-invmsg=\"Disclosures - Conflict of Interest is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_673-1\">\t\t\t<label  for=\"field_qvlp07-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[673]\" id=\"field_qvlp07-1\" value=\"No\"\n\t\t data-reqmsg=\"Disclosures - Conflict of Interest cannot be blank.\" data-invmsg=\"Disclosures - Conflict of Interest is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div id=\"frm_desc_field_qvlp07\" class=\"frm_description\">Do you have a financial interest (current or potential), including a compensation arrangement, that would be in conflict as defined in the Conflict of Interest policy with AvaCon, Inc.?<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_674_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_4uxt8e\" class=\"frm_primary_label\">Disclosure - Explain Conflict of Interest\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[674]\" id=\"field_4uxt8e\" rows=\"5\"  data-invmsg=\"Disclosure - Explain Conflict of Interest is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_4uxt8e\"><\/textarea>\r\n    <div id=\"frm_desc_field_4uxt8e\" class=\"frm_description\">If yes above, please explain.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_675_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label  class=\"frm_primary_label\">Disclosures - Past Conflict of Interest\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_675-0\">\t\t\t<label  for=\"field_q4u695-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_q4u695-0\" value=\"Yes\"\n\t\t data-reqmsg=\"Disclosures - Past Conflict of Interest cannot be blank.\" data-invmsg=\"Disclosures - Past Conflict of Interest is invalid\"   \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_675-1\">\t\t\t<label  for=\"field_q4u695-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[675]\" id=\"field_q4u695-1\" value=\"No\"\n\t\t data-reqmsg=\"Disclosures - Past Conflict of Interest cannot be blank.\" data-invmsg=\"Disclosures - Past Conflict of Interest is invalid\"   \/> No<\/label><\/div>\n<\/div>\r\n    <div id=\"frm_desc_field_q4u695\" class=\"frm_description\">In the past have you had a financial interest, including a compensation arrangement, that would be in conflict as defined in the Conflict of Interest policy with AvaCon, Inc.?<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_676_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_e6b1m4\" class=\"frm_primary_label\">Disclosure - Explain Past Conflict of Interest\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[676]\" id=\"field_e6b1m4\" rows=\"5\"  data-invmsg=\"Disclosure - Explain Past Conflict of Interest is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_e6b1m4\"><\/textarea>\r\n    <div id=\"frm_desc_field_e6b1m4\" class=\"frm_description\">If yes above, please explain.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_677_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_5ujmjn\" class=\"frm_primary_label\">Electronic Signature\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_5ujmjn\" name=\"item_meta[677]\" value=\"\"  data-reqmsg=\"Electronic Signature cannot be blank.\" aria-required=\"true\" data-invmsg=\"Electronic Signature is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_5ujmjn\"\/>\r\n    <div id=\"frm_desc_field_5ujmjn\" class=\"frm_description\">By entering your first and last name in the text box, you indicate that you are electronically signing this document and all statements are true and accurate to the best of your knowledge. You further agree that any misrepresentation, false statement, or omission, made by you with respect to the information contained in this submission shall be sufficient cause to terminate your employment, membership, or sufficient cause to remove you from any Office or position of authority with AvaCon, Inc.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_678_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_t496c\" class=\"frm_primary_label\">Email Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_t496c\" name=\"item_meta[678]\" value=\"\"  data-reqmsg=\"Email Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Email Address is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_703_container\">\n\t\t\t<label for=\"field_33xf5\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_33xf5\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[703]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"as7lhoZmdL4RjPK9tgyaKTwVQ8vxGrlTsuAyoHg3pdY=\" \/><div class=\"frm_submit\">\r\n\r\n<input type=\"submit\" value=\"Submit\"  \/>\r\n<img decoding=\"async\" class=\"frm_ajax_loading\" src=\"https:\/\/www.avacon.org\/blog\/wp-content\/plugins\/formidable\/images\/ajax_loader.gif\" alt=\"Sending\" style=\"visibility:hidden;\" \/>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"101\"\/><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n\/* ]]> *\/\n<\/script>\n<\/p><\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>Annual Directors Conflict of Interest Policy Form All members of the AvaCon Executive Board, Officers, and Directors are required to annually review the AvaCon Conflict of Interest Policy and complete the form below. &nbsp;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":9,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-573","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.avacon.org\/blog\/wp-json\/wp\/v2\/pages\/573","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.avacon.org\/blog\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.avacon.org\/blog\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.avacon.org\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.avacon.org\/blog\/wp-json\/wp\/v2\/comments?post=573"}],"version-history":[{"count":0,"href":"https:\/\/www.avacon.org\/blog\/wp-json\/wp\/v2\/pages\/573\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.avacon.org\/blog\/wp-json\/wp\/v2\/pages\/9"}],"wp:attachment":[{"href":"https:\/\/www.avacon.org\/blog\/wp-json\/wp\/v2\/media?parent=573"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}