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Group I Conflict of Interest Disclosure Statement

The form below is for the date range June 1, 2017–May 31, 2018.

I am completing this disclosure statement to qualify for service as (check all applicable)


By submitting this form, I HEREBY CONFIRM that I have read and understand the
NYSSCPA/FAE Conflict of Interest Policy
 and that, to the best of my knowledge, my responses to the above questions are complete and correct. I agree to recuse myself from any Society- and FAE-related decisions in which I believe I might have a Conflict of Interest.