Annual Conflict of Interest Disclosure Statement

INTERNATIONAL AERIAL COMBAT SPORT FEDERATION Annual Conflict of Interest Disclosure | IACSF-FORM-GOV-004

INTERNATIONAL AERIAL COMBAT SPORT FEDERATION

ANNUAL CONFLICT OF INTEREST DISCLOSURE

To be completed annually by all Directors, officers, committee members, and senior officials — due by February 1 each year

IACSF-FORM-GOV-004

PART A — DECLARANT INFORMATION

Full Legal Name		Disclosure Year
IACSF Role(s) / Position(s)		Date Completed
Member Team Affiliation (if any)		IACSF License / ID No.

☐ This is my first annual disclosure. ☐ I submitted a prior disclosure (year: ____________). ☐ My circumstances have materially changed since my last disclosure.

PART B — FINANCIAL INTERESTS

Disclose any financial interests you or a close family member hold in any entity that has, or may have, a relationship with the IACSF. Include ownership interests, employment arrangements, consulting agreements, or significant contractual relationships. List all that apply; use additional pages if needed.

PART C — OUTSIDE POSITIONS AND EMPLOYMENT

List all positions (paid or unpaid) you currently hold outside the IACSF, including board memberships, advisory roles, employment, and consulting arrangements, where those organizations have or may have a relationship with the IACSF.

Organization Name & Role
Nature of IACSF Relationship (if any)
Organization Name & Role
Nature of IACSF Relationship (if any)

☐ I have no outside positions or employment to disclose.

PART D — GIFTS AND HOSPITALITY RECEIVED

List all gifts, benefits, or hospitality received from any entity with an IACSF relationship during the prior calendar year with an individual value exceeding USD $100, or an aggregate value from one source exceeding USD $250. (Items reported on a previously submitted IACSF-FORM-GOV-001 during the year need not be repeated if copies are attached.)

Gift / Benefit Description
Giver (Name & Organization)
Date & Estimated Value
Accepted / Declined

☐ I have no gifts or hospitality to disclose above the threshold.

PART E — CHANGES FROM PRIOR DISCLOSURE

If you submitted a prior annual disclosure, describe any material changes in your circumstances that affect previously disclosed or previously undisclosed conflicts of interest.

Description of Changes

☐ No material changes from my prior disclosure.

PART F — DECLARATION AND SIGNATURE

I declare that the information provided in this Annual Conflict of Interest Disclosure Statement is true, accurate, and complete to the best of my knowledge and belief as of the date signed. I understand that this disclosure is a condition of my continued service in my IACSF role, and that any material omission or misrepresentation may result in disciplinary action including removal from my position.

I commit to promptly updating this disclosure by submitting an IACSF-FORM-GOV-003 if any material change in my circumstances occurs before my next annual disclosure.

Signature	Date
Printed Name	Role / Position

FOR IACSF USE ONLY — ANNUAL DISCLOSURE REVIEW

Received By
Date Received
Action Taken
File Reference

Annual disclosure is due by February 1 each year for all Directors, officers, committee members, and senior officials. Submit to: commissioner@iacsf.org. Retain for minimum 7 years. Any disclosures requiring Board action are flagged by the Commissioner and placed on the next Board agenda.