AMP Board & Committee Governance Disclosures Submission Form

Disclosure of the following information is required of all members of the AMP Board and Committees who have decision-making responsibilities. Please answer the following questions and include the same information for persons with a close legal relationship.
SECTION A: Your Employer
SECTION B: Volunteer Service
SECTION C: Financial Disclosures

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By submitting this form below, I:
(1) acknowledge that I have received and read the Association for Molecular Pathology Statement of Fiduciary Responsibility available at http://www.amp.org/about/get_involved.cfm;
(2) promise to serve AMP to the best of my ability and with the highest degree of duty, loyalty, and care;
(3) promise to conduct and hold all AMP matters in confidence;
(4) will neither disclose information nor distribute materials obtained; and
(5) attest that I do not have any actual, apparent or potential conflicts of interest which are not listed below.

I understand that it is my responsibility to inform the Executive Director in writing of any change in circumstances relating to the Statement of Fiduciary Responsibility.

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    SECTION A: YOUR EMPLOYER

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