* Required Information

I have read and am fully familiar with the Agency’s policy statement regarding conflict of interest. I am not presently involved in any transaction, investment, or other matter in which I would profit or gain directly or indirectly as a result of my membership in the Agency’s Governing Body or its committees or my employments. Furthermore, I agree to disclose any such interest which may occur in accordance with the requirements of the policy and agree to abstain from any vote or action regarding the Agency’s business that might result in any profit or gain directly or indirectly of me.