C.O.I – For TGMS Society Members PLEASE READ: POLICY and PROCEDURES Agreement and Disclosure Form Date(Required) MM slash DD slash YYYY Name(Required) First Last Email(Required) Position (Board/Staff/Committee Member):(Required) TGMS Board Member TGMS Staff TGMS Committee Member Untitled(Required) I have read the Tucson Gem and Mineral Society Conflict of Interest Policy and Procedures (the “Policy”) and I agree to abide by that Policy and all procedures set forth in it with regard to any conflict of interest that currently exists or that may exist or may occur in the future.(Required)Please check the appropriate box:(Required) At this time, I have no conflict of interest to report. I am aware of a current actual or possible conflict of interest, and I have made the disclosures required by the Policy. I agree to recuse myself from any discussion or decision making relating to the conflict of interest unless I am asked to provide information regarding the same. Electronic Signature(Required) I acknowledge use of Electronic SignatureBy entering my name below; I hereby certify that the information set forth above is true and complete to the best of my knowledge.Signature(Required) Please type your full name.