I, ________________________________, a member of the United Soybean Board (the Board), have received, read and understood the Board’s Conflict of Interest and Gift Policy.

_______ To the best of my knowledge, I do not have any relationship with any organization/person that is transacting, has transacted or may transact business with the Board.

_______  To the best of my knowledge, I have a relationship with organizations/persons that may give rise to a conflict of interest. Please identify below the organizations/persons, the nature of the relationship and the nature of the transaction. Attach additional sheets if necessary.
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Please list all gifts valued at more than $50 that you have received in the past year from organizations/persons who have transacted, are transacting or may transact business with the Board.  Attach additional sheets if necessary.
______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Please identify all travel-related benefits that you have received in the past year from organizations/persons who have transacted, are transacting, or may transact business with the Board.  Attach additional sheets if necessary. ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________
I understand that if a conflict of interest does arise after this disclosure, I will report it to one of the Board officers immediately.

__________________________________               
Board Member’s Signature

__________________________________
Printed Name

________________
Date