2020 NSGC Volunteer COI Disclosure Policy and Form

NSGC CONFLICT OF INTEREST DISCLOSURE POLICY (approved April 15, 2013, re-affirmed February 25, 2019)

The National Society of Genetic Counselors (NSGC) promotes the professional interests of genetic counselors and provides a network for professional communication. Local and national continuing education opportunities and the discussion of all issues relevant to human genetics and the genetic counseling profession are an integral part of membership in NSGC. NSGC is dedicated to advancing the various roles of genetic counselors in health care by fostering education, research, and public policy to ensure the availability of quality genetic services.

The integrity of NSGC, and the activities it undertakes, depends on the avoidance of conflicts of interest, or even the appearance of such conflicts, by the individuals involved in those activities. At the same time, NSGC recognizes that its members have significant professional, business and personal interests and relationships. Therefore NSGC has determined that the most appropriate manner in which to address actual, potential or apparent COI is initially through liberal disclosure of any relationship or interest which might be construed as resulting in such a conflict. Disclosure under this Conflict of Interest Policy (Policy) should not be construed as creating a presumption of impropriety or as automatically precluding someone from participating in an NSGC activity or decision-making process. Rather, it reflects NSGC’s recognition of the many factors that can influence one’s judgment and a desire to make as much information as possible available to other participants in NSGC-related matters.

Any individual involved in an NSGC activity or decision-making process has an obligation to disclose any conflicting or potentially conflicting personal, professional, or business interests he/ she may have, directly or indirectly, with the affected activity or decision. Potentially conflicting interests may relate to NSGC’s programs and services (e.g., educational courses) or its operations (e.g., contracts with third parties). In the event that an officer, director, or member of an NSGC Task Force, SIG group, or other committee (collectively, referred to herein as “committee members”) determines that he /she has a COI on a particular matter, he/ she shall disclose the conflict to the NSGC’s Board of Directors or to the other committee members, as applicable.

In addition, participants in NSGC-related activities are obligated to disclose the positions they hold or relationships they have with other organizations or entities that may conflict, directly or indirectly, with their NSGC activities. They also have an obligation to disclose any significant financial interest in, or other relationship with, an entity having a “commercial interest” in the activity. A commercial interest may exist not only where the entity’s products or services are under consideration by NSGC, but also where the entity’s products or services are in competition or potential competition with those under consideration. By the disclosure of such interests, other participants will have the opportunity to take potential biases into consideration. In addition, the Board of Directors (or, as applicable, committee members) will be in a better position to determine whether the participant may have an interest in conflict with the interests of NSGC.

To help assure full disclosure of any actual or potential COI, all participants in NSGC-related activities, including the NSGC’s staff, officers, directors, and committee members must comply with this Policy and annually sign and submit a Disclosure Form (a copy of which is attached hereto) (i) acknowledging that he/ she is aware of and has read the Policy; and (ii) disclosing the information described above. If, subsequent to any such annual disclosure (but prior to execution of a new annual Disclosure Form), an NSGC officer, director, or staff or committee member becomes aware of a relationship required to be so disclosed, that officer, director, staff, or committee member shall promptly make the required disclosure by submitting a revised Disclosure Form identifying the organization, business, group, entity, etc., and describing the nature of the relationship.

It is the responsibility of the disinterested members of the Board of Directors or, as applicable, committee members, to interpret and apply this Policy. And, inasmuch as the Policy is stated in general terms, the Board of Directors or its designee(s) should use their best judgment applying this policy.

Question Title

* 1. Please provide your name and contact information.

Name:

Employer: *

Address:

Address 2:

City:

State/Province:

ZIP/Postal Code

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* 2. Please indicate the NSGC Committee(s), Task Force(s) or other volunteer role(s) in which you are or will be involved during 2020 (please check all that apply)

Access and Service Delivery Committee (including subcommittees)

AHSPA Committee

Board of Directors

CEU Review Subcommittee

Education Committee (including conference Program Committee, Online Course, Webinar, Podcast and JGC CEU subcommittees)

Abstract Workgroup

Ethics Advisory Group

Finance Committee

JEMF Advisory Group

DEI Advisory Group

Marketing & Communications Workgroup

Membership Committee

Nominating Committee

Research/Outcomes Committee

Practice Guidelines Committee

Public Policy Committee

SIG Chair or Vice Chair (indicate SIG below)

Task Force (indicate Task Force below)

NSGCares Work Group

Other (indicate below)

Please specify SIG, Position Statement, Guideline, Task Force, Subcommittee or other group as applicable.

CONFLICT OF INTEREST DISCLOSURE FORM

I affirm that the following are all of my (including my immediate family and household) material business, financial, and organizational interests and affiliations which are or could be construed to be reasonably related to the interests, activities, and programs of NSGC:

Please complete the following form. If you have no information to list, please state “None.”

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* 3. Business Interests and Positions: Please list any memberships on boards, offices held, employment or consulting arrangements or other affiliations you have had within the previous 12 months (or reasonably expect to have within the next 12 months) with any organization, business, group, agency, or other entity that has done business with, or potentially competes with, NSGC, or that you reasonably believe may do business with, or compete with, NSGC.

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* 4. Material Ownership Interests: Please list any material ownership interests (including stock options but excluding indirect investments through mutual funds and the like) in any entity that has a commercial interest in any activity, contract, or matter directly related to the activities of NSGC (just the fact of ownership must be reported and not the actual amount of such holdings).

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* 5. Organizational Interests and Positions: Please list any leadership roles or positions you have held (e.g., board member, committee member, chair, president, advisor, contributor) in any organization, business or other entity that involves, or may be perceived to compete with, or be contrary to the interests of NSGC.

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* 6. Actual, Potential, or Apparent Conflicts: Please list any other activities, positions, or interests you engage in, hold, or anticipate engaging in or holding that reasonably could be perceived to conflict with the interests of NSGC.

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* 7. I have read, understand and agree to the terms of NSGC’s Conflict of Interest Policy. To the best of my knowledge and belief, the information reported above is complete and accurate, and I am not aware of any other personal or professional position(s) or interest(s) or activities in which I am, or am about to be, engaged that reasonably may be anticipated to conflict with the interests of NSGC.

I submit my electronic signature by checking this box.