Conflict of Interest Form

This is to certify that I, except regarding carrying out my duties as a board member of the Regional Arts Commission or as described below, am not now nor at any time during the past year have been:

  1. A participant, directly or indirectly, in any arrangement, agreement, investment, or other activity with any vendor, supplier, or other party; doing business with the Regional Arts Commission which has resulted or could result in personal benefit to me.
  2. A recipient, directly or indirectly, of any salary payments, consulting fees or loans or gifts of any kind or any free service or discounts or other fees from or on behalf of any person or organization engaged in any transaction with the Regional Arts Commission. Except for no more than 2 tickets for any single available performance offered to the Commissioners by organizations funded by the Regional Arts Commission per the contract signed by the organization.

Any exceptions to 1 or 2 above are stated below with a full description of the transactions and of the interest, whether direct or indirect, which I have (or have had during the past year) in the persons or organizations having transactions with the Regional Arts Commission.


In addition to my service for the Regional Arts Commission, now I am a Board member, ex-officio board member, advisory board member, volunteer, contractor, consultant or an employee of the following organizations:

Conflict of Interest

RAC Grantee Disclosure

Other Non-Profit Disclosure

For-Profit Disclosure

Typing your name here indicates your signature on this form.