[COMMUNITY] Conflict of Interest Disclosure

Version: 1.1.0
Review date: [DATE]
Name: [NAME]
Role in community: [MEMBER / HOST / EDITOR / SPONSOR / SPEAKER]

Please disclose relationships that could reasonably affect, or appear to affect, your participation in [DECISION, SESSION OR PUBLICATION].

Financial or commercial interests: [DETAIL / NONE]
Employment or advisory roles: [DETAIL / NONE]
Investor, board or governance relationships: [DETAIL / NONE]
Competitive or portfolio conflicts: [DETAIL / NONE]
Personal relationships relevant to the decision: [DETAIL / NONE]
Other material interests: [DETAIL / NONE]

Proposed management: [DISCLOSURE / RECUSAL / SESSION SEPARATION / OTHER]
Decision owner: [NAME]
Decision and review date: [DETAIL]

I confirm this disclosure is accurate to the best of my knowledge and will update it if circumstances change.

Signature / date: [NAME / DATE]

Disclaimer: This operating form is not legal, fiduciary or compliance advice.