Initial Conflict of Interest Disclosure and Affirmation Form
A. Conflict of Interest Disclosures. I have described below, to the best of my knowledge,
(1) The names of all entities of which I am, or any relative* is, an officer, director, trustee, member, owner (either as a sole proprietor, member, partner or substantial equity holder having thirty-five percent or greater ownership or beneficial interest or, in the case of partnership or professional corporation, a direct or indirect ownership interest in excess of five percent) or employees and with which Westchester Ballet Company, Inc. (the “Corporation”) (including any affiliate of the Corporation) has an existing or proposed relationship and the nature of such role:
*“Relative” means spouse; domestic partner as defined in New York Public Health Law Section 2954-A; ancestors; brothers and sisters (whether whole or half-blood); children (whether natural or adopted); grandchildren; great-grandchildren; and spouses or domestic partner of brothers, sisters, children, grandchildren, and great-grandchildren.