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Steve Dogiakos 2023-02-16 16:34:47 +00:00 committed by gitbook-bot
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@ -71,9 +71,11 @@ When conducting the periodic reviews as provided for in Article VII, TMDC may, b
Revision History by the TMDC Board Revision History by the TMDC Board
Initial Conflict of Interest policy adopted April ,2020 Initial Conflict of Interest policy adopted April 2020, re-affirmed February 2023.
Montana Dinosaur Center Director & Officer Conflict of Interest Statement ### Montana Dinosaur Center Director & Officer 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:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. 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)\ 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)\
@ -85,10 +87,8 @@ Montana Dinosaur Center Director & Officer Conflict of Interest Statement
1. If yes, please describe it, including when (approximately): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 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 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 5. Are you an independent director, as defined in the Conflict of Interest policy? Yes No
* If you are not independent, why? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ * If you are not independent, why? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*** Signature of Director\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Signature of Director Date Date of Review by Executive Committee: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date of Review by Executive Committee: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_