Conflict of interest Disclosure Form

The purpose of this form is to disclose conflicts of interest between board members and the Ag Data Transparency Evaluator Inc. (“ADT”). Any person serving as a board member of ADT shall annually complete this form. For a copy of the ADT Conflict of Interest Policy, contact the board president or administrator.

Your responses shall be kept on file by the ADT and shared only with the board president, administrator, and if necessary, the current board of directors. Information contained in this form may also be provided to the ADT’s accountants and the IRS and appropriate state tax authorities. You may change or update your responses at any time by contacting the board president or administrator.


Please complete the form below

Name *
Address of Employer *
Address of Employer
I have received a copy of the ADT's Conflict of Interest Policy

*Required information