Board of Governors Conflict of Interest Form

Name*
I am making this disclosure to inform the Board of Governors of the following actual, potential, or perceived conflict of interest:*

Describe the nature of the conflict of interest, including the relationship, transaction or circumstance that creates or could potentially create a conflict of interest. Be as specific as possible.
The conflict arises from the following situation:*

Provide details about how the conflict. Explain the timeline, nature of business relationships, decision-making roles, etc. that pertain to the conflict.
My role in the situation is:*

Explain your designated responsibilities or decision-making authority in the situation where the conflict exists.
The measures I have taken to mitigate the conflict of interest are:*

Describe actions taken to address the conflict, such as recusal from certain matters, divestment of relationships/assets, or requesting a waiver or exception.
To the best of my knowledge, the above information is true and represents a complete disclosure of all actual, potential or perceived conflicts of interest I currently have in relation to my role and responsibilities as a member of the State Bar of Nevada Board of Governors. I agree to update this form promptly if any new conflict arises.
- Agree
- Disagree
Comments

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