Chamber Committee Conflict of Interest Form

This form is to ensure transparency and maintain the integrity of committee decisions by disclosing any personal, professional, or financial conflicts of interest. By completing this form, you acknowledge your responsibility to act in the best interest of the Chamber and its membership.

Fields marked with an * are required.

First Name *

Last Name *

Chamber Committee *

Conflict of Interest Policy Overview *

A conflict of interest exists when a committee member’s personal, financial, or professional interests may influence or appear to influence their ability to act in the best interests of the Santa Maria Valley Chamber and its membership.

As a committee member, you must disclose any actual, potential, or perceived conflicts of interest before participating in any discussions or decision-making processes related to those interests.

Disclosure Statement

Do you, your immediate family, or your business have any financial interest, personal interest, or professional relationships that may pose a conflict with your responsibilities as a committee member?

Yes

If yes, please describe the nature of the conflict

Conflicts of Interest *

Do you hold any positions (board memberships, employment, consulting, etc.) with other organizations that may present a conflict with the interests of the Chamber?

Yes

If yes, please describe

Certification of Information *

By typing my name below, I certify that the information provided in this form is true and complete to the best of my knowledge. I agree to update this form if my circumstances change during my service on the committee. I also agree to recuse myself from discussions or decision-making where a conflict of interest exists.

Date (mm/dd/yyyy) *

Please verify that you have checked the “I'm not a robot” checkbox.