Complete the form below and click submit to:

  • Verify you have read the RRCA Board policies that require affirmative agreement. 
  • Provide your  relationship disclosures that are required as part of the Conflict of Interest Policy.
Name

Conflict of Interest Disclosures

Your professional title. If retired note that here. If self-employed note owner as your occupation.
Name of employer or outline if you are retired. If self-employed, outline name of your company.

Relationship Disclosures

Below I have outlined relationships, interests, or situations involving me, my employer, or a member of my family, which might result in, or appear to be an actual, apparent, or potential conflict of interest between me, my employer, or such family members and the Road Runners Club of America.
Outline memberships in other organizations you are involved with including your local club:(Required)
Organization Name
Role in Organization (Member, Director, Officers, etc)
 
Click + to add organizations
Outline all for-profit corporate directorships, positions, and employment with:
Organization Name
Role in Organizaton
 
Click + to add organizations
Outline other relationships and activities that may present a conflict of interest:
Organization Name
Role in Organization (Member, Director, Officers, etc)
 
Click + to add organizations
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