diff --git a/SUMMARY.md b/SUMMARY.md
index 7189327..54c39c4 100644
--- a/SUMMARY.md
+++ b/SUMMARY.md
@@ -5,7 +5,7 @@
   * [Board Member Conflict of Interests Disclosure Form](conflict-of-interest-policy/board-member-conflict-of-interests-disclosure-form.md)
   * [Digital Board Member Conflict of Interests Disclosure Form](https://forms.monday.com/forms/41bc9a5f10faa5d53a8c49558c633d70?r=use1)
   * [Digital Conflict of Interest Statement](https://forms.monday.com/forms/9501dd91aed9008061d31455fc6cf45a?r=use1)
-  * [Montana Dinosaur Center Director & Officer Conflict of Interest Statement](conflict-of-interest-policy/montana-dinosaur-center-director-and-officer-conflict-of-interest-statement.md)
+  * [Conflict of Interest Statement](conflict-of-interest-policy/conflict-of-interest-statement.md)
 * [Board Communication Policy](board-communication-policy.md)
 * [Strategic Reserve Policy](strategic-reserve-policy.md)
 * [Financial Policy](financial-policy.md)
diff --git a/conflict-of-interest-policy/conflict-of-interest-statement.md b/conflict-of-interest-policy/conflict-of-interest-statement.md
new file mode 100644
index 0000000..bd742ab
--- /dev/null
+++ b/conflict-of-interest-policy/conflict-of-interest-statement.md
@@ -0,0 +1,19 @@
+# Conflict of Interest Statement
+
+[Also available digitally](https://forms.monday.com/forms/9501dd91aed9008061d31455fc6cf45a?r=use1)
+
+1. Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Are you a member in Good Standing? Yes No What organization or other membership affiliation do you represent? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Position: Are you a voting Director? Yes No Are you an Officer? Yes No If you are an Officer, which Officer position do you hold:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
+2. I affirm the following: I have received a copy of the TMDC Conflict of Interest Policy. \_\_\_\_\_\_\_\_\_ (initial) I have read and understand the policy. \_\_\_\_\_\_\_\_\_ (initial) I agree to comply with the policy. \_\_\_\_\_\_\_\_\_ (initial) I have reviewed the Board Member Job Description. \_\_\_\_\_\_\_\_\_ (initial) I understand that TMDC is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of tax-exempt purposes. \_\_\_\_\_\_\_\_\_ (initial)\
+   Disclosures:
+3. Do you have a financial interest (current or potential), including a compensation arrangement, as defined in the Conflict of Interest policy with TMDC? Yes No
+   1. If yes, please describe it: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
+   2. If yes, has the financial interest been disclosed, as provided in the Conflict of Interest policy? Yes No
+4. In the past, have you had a financial interest, including a compensation arrangement, as defined in the Conflict of Interest policy with TMDC? Yes No
+   1. If yes, please describe it, including when (approximately): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
+   2. If yes, has the financial interest been disclosed, as provided in the Conflict of Interest policy? Yes No
+5. Are you an independent director, as defined in the Conflict of Interest policy? Yes No
+   * If you are not independent, why? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
+
+Signature of Director\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
+
+Date of Review by Executive Committee: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_