Conflict of Interest Declaration Form
Please complete this form to disclose any conflicts of interest and support transparency.
Full Name
*
First Name
Last Name
Position / Role
*
Email Address
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you have a current conflict of interest to declare?
*
Yes
No
Please describe the conflict of interest
*
Who or what organisation/business is connected to this interest?
*
Type of conflict
*
Actual Conflict
Potential Conflict
Perceived Conflict
This conflict relates to
*
Family relationship
Employment or business relationship
Sponsorship
Financial interest
Supplier or procurement matter
Media or promotional arrangement
Coaching or player relationship
Governance or voting matter
External organisation involvement
Other
Suggested management option
Disclosure only
Abstain from voting
Abstain from discussions
Committee review required
Other
Additional comments
Are you related to any current committee member, coach, volunteer, or staff member?
*
Yes
No
If Yes, please provide details
Do you currently work for, represent, or receive income from any organisation connected to the club?
*
Yes
No
Organisation name
Relationship to club
Do you or any related party provide sponsorship, goods, services, discounts, or support to the club?
*
Yes
No
If Yes, please provide details
Could this interest influence, or appear to influence, your decision-making within the club?
*
Yes
No
Unsure
Are there any club matters where you believe you should not participate in voting or decision-making?
*
Yes
No
If Yes, please provide details
Have you previously disclosed this conflict to the club?
*
Yes
No
I understand that declaring a conflict of interest does not automatically prevent participation in club activities, but allows the club to manage governance transparently and fairly.
*
I agree
I understand this information will be securely maintained within the club’s governance and compliance records.
*
I agree
Digital Signature
*
Submit Declaration
Submit Declaration
Should be Empty: