To the extent that I have served in any of the following capacities for any company, organization, or other entity or person over the past 12 months, or anticipate doing so in the next 12 months, I hereby disclose individually (a) the type of relationship; (b) the identity of the organization, company, or other relevant entity or person involved; (c) a description of the activity sufficient to allow the ACHA Board of Directors to make a determination as to the existence of a conflict of interest; and (d) the financial compensation status (i.e. yes/no).
I shall also disclose any other direct and indirect (e.g. through a close family member or a business associate) business, professional, or personal situations and relationships that might influence, or that might be perceived to influence, my judgement or actions relative to my service for ACHA, during the past 12 months and anticipated during the next 12 months.
I agree.