Conflict of Interest Statement

For Officers, Directors, Committee, and Staff Members

No member of The Blood Cancer Foundation of Michigan (BCFM), formerly known as Children's Leukemia Foundation of Michigan (CLF) Board of Directors, any of its Committees, or Staff shall derive any personal profit or gain, directly or indirectly, by reason of his or her participation with BCFM. Each individual shall disclose to BCFM any personal interest which he or she may have in any matter pending before BCFM and shall refrain from participation in any decision on such matter.

Any member of the BCFM Board, any Committee or Staff who is an officer, board member, a committee member or staff member of a company or agency with which BCFM seeks or maintains an active vendor relationship shall identify his or her affiliation with such organization or agencies. In addition, he or she shall not participate in the decision affecting that agency.

All contracts with organizations or agencies where there exists a relationship with a member of the Board, Committee or Staff members of BCFM will be reviewed annually by the Executive Committee of the BCFM Board of Directors.

Any member of the BCFM Board, or any Committee or Staff shall refrain from obtaining any list of BCFM clients or donors for personal or private solicitation purposes at any time during the term of their affiliation.

At this time, I am a Board member, a Committee Member, or an Employee of the following organizations:

Now this is to certify that I, except as described below, am not now nor at any time during the past year have been: 1) A participant, directly or indirectly, in any arrangement, agreement, investment, or other activity with any vendor, supplier, or other party doing business with BCFM which has resulted or could result in personal benefit to me. 2) A recipient, directly or indirectly, of any salary payments or loans or gifts of any kind or any free service or discounts or other fees from or on behalf of any person or organization engaged in any transaction with BCFM. Any exceptions to 1 or 2 above are stated below with a full description of the transactions and of the interest, whether direct or indirect, which I have (or have had during the past year) in the persons or organizations having transactions with BCFM.

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