WESTCHESTER BALLET COMPANY INC. (“WBC”)

Report of Potential or Actual Related Party Transaction and/or Conflict of Interest

WBC has created this form to ensure that it is made aware of any relationship or transaction involving its Board members, employees or contractors and another individual involved with WBC, which may result in a Related Party Transaction (a transaction between two parties who have a preexisting business relationship or common interest) or create an actual or potential conflict of interest. Such relationships/transactions are not illegal or inappropriate per se, but must be disclosed so that the uninvolved members of the WBC Board can review the situation and take any steps necessary to ensure WBC operates with good governance and at the highest level of transparency and integrity.

By signing this form and submitting it to the WBC Board President/Chair, I acknowledge that I cannot be present at or participate in WBC Board or Board committee discussions on the RPT/conflict of interest, nor can I attempt to improperly influence the vote on the RPT/conflict of interest.  I recognize that the Board or Board committee may ask me for additional details about the situation and that I may provide the Board or Board committee with additional information, within the confines of WBC’s Conflict of Interest Policy and the law.