Collective Action Fund Independent Advisory Committee Member Recertification

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Independent Advisory Committee Member information can only be submitted by invitation only. If you have reached this page without a direct invitation from the Fund, please reach out to your Fund Manager.

Invited?

In order to submit this form you must have a custom link provided to you from your advisor at Tides. Please reach out to your advisor if you need this information resent to you.

Tides Fund Name

Independent Advisory Committee Member Name

First

Last

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Conflict On Interest

Conflict of Interest Statement

I have no Conflicts of Interest as defined in the Tides Conflict of Interest Policy linked below to report regarding the fund named above

In compliance with the Conflict of Interest Policy linked below, I hereby report the following relationships, interests, or situations involving me or a Related Party (as defined in the Conflict of Interest Policy) that might result in or appear to be an actual, apparent or potential conflict of interest in connection with my duties and responsibilities to Tides

Positions that you or any of your immediate family members (e.g., parents, siblings, spouses and children), has with organizations or businesses that may have a relationship with the Fund, including an affiliated C4 entity that may receive charitable grants from this Fund:

Relationships that you or any of your immediate family members has with known donor(s) to the Fund:

Any employment or contracting services of behalf of a foreign principal, or any close working relationships with a foreign principal:

Any affiliation with a foreign principal that would affect decision making as an IAC member:

Any other relationships and organizational affiliations/information that may be relevant to identifying potential conflicts:

My primary business or occupation at this time:

I am not aware of any financial interest involving me or a family member that could present a conflict of interest that I have not disclosed either above or in a previous disclosure statement.

I will promptly notify the Fund’s Tides Advisor of any material change in the above disclosure.

Please note: This form uses an e-signature process. Once you provide your e-signature, you will then receive an email with a link to verify your e-signature. As many email services now pre-click links for security, this may count towards the verification. If you click the link and see an error page with language stating that you "Cannot verify signatory for a completed e-signature record", this means it's already been verified and successfully submitted.

Contact Information