Lamaze Conflict of Interest Policy Acknowledgement Form
 
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Lamaze Conflict of Interest Policy Acknowledgement Form


Thank you for your time and commitment to Lamaze International. 

Lamaze International considers it important that there be a full understanding of and confidence in the honesty and integrity of Lamaze International’s business dealings, that adequate steps are taken to assure that all actions are for the benefit of the organization, and that no presenters or planners of continuing education activities provided for Lamaze Contact Hours have, or may be perceived to have, a divided loyalty or other interest which may be in conflict with his or her role with Lamaze International.

Complete the Conflict of Interest Form

The mission of Lamaze International is to advance safe and healthy pregnancy, birth and early parenting through evidence-based education and advocacy. Any advertising in connection with a program that is approved for Lamaze Contact Hours must be in compliance with the Lamaze Advertising Standards Policy. No advertising may do anything to negatively affect the mission or reputation of Lamaze International. Consistent with its philosophy on breastfeeding, Lamaze International abides by the World Health Organization Code of Marketing Breastmilk Substitutes and its resolutions (WHO Code). Compliance with WHO Code advertising provisions is applicable to the product or service being advertised, not to the entire corporation. Lamaze International reserves the right to decline or prohibit any advertising which, in its sole discretion, is inappropriate or contrary to its policies. This reservation is all-inclusive as to persons, things, printed matter, website content, inserts and coupons, product samples, video and conduct.

These advertising guidelines are applicable to all Lamaze consumer and professional publications and media, and all Lamaze educational events, including the annual conference, workshops (hosted publicly or privately), online education programs and Lamaze Childbirth Educator Programs. Acceptance as an advertiser, exhibitor or sponsor can not be viewed as an endorsement of any product.

Please review the policies below and complete the online conflict of interest form.

 

Policy

  1. Governance: Conflict of Interest Policy and Disclosure Form – April 2016
  2. Administration: Advertising Standards – June 2015

I acknowledge that I have received, read, and understood the Lamaze International policies listed above. I hereby certify that I understand and agree to comply with the policies.

I further acknowledge that I am responsible for complying with all Lamaze policies as they may be updated from time to time, including Lamaze policies not listed above.

 

Conflict of Interest Disclosure Form

Please answer the following questions about your outside activities that might be related to Lamaze International, its programs, or the field of childbirth education. Overlapping interests frequently arise in nonprofit organizations and are normal. It is a reflection that dedicated and well-qualified individuals often play multiple roles within a professional field. The key is to be aware of the possibility for actual as well as perceived conflicts and to be prepared to manage them in a fair and open manner. In responding to these questions, please note that a “yes” answer does not automatically indicate that the relationship or transaction was inappropriate.

Please list the companies and other places where you perform paid work (employers, commercial companies, research institutions, government agencies, etc.).

Please list the organizations and other places where you volunteer or otherwise perform unpaid work as an officer, director, committee member, etc.

Do you, either personally or through a related business entity, conduct business with Lamaze International (e.g., as a paid Lamaze Workshop Instructor, Lamaze Program Trainer, etc.), or do you have any connection with a vendor that is doing business with Lamaze International?

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If any of your family members or business associates have a connection with Lamaze International or the field of childbirth education similar to the questions asked about you above, then please describe those connections here.

Please list any other information that you think might be helpful for Lamaze International to know about you, your family members, and your business associates.

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I acknowledge that I have received and read the Lamaze International Conflict of Interest Policy. I do not have any undisclosed actual, apparent, or potential conflicts of interest which are not listed in this Disclosure Statement and agree to abide by the Conflict of Interest Policy. I understand that it is my responsibility to inform Lamaze in writing of any change in circumstances relating to the Conflict of Interest Policy.

In the event that any matter comes before the Corporation’s Board of Directors or any committee of which I am a member involving any matter in which I or a member of my immediate family have a substantial financial interest (by way of ownership, employment, or otherwise), or any transaction with any entity in which I act as a director, partner, trustee, or officer, I shall notify the Board of Directors or the appropriate committee, as the case may be, of the existence and extent of such interest or capacity, and I shall refrain from voting and from using my personal influences thereon. I shall, of course, make available to the other members of the Board or committee, as the case may be, any pertinent information in my possession with respect to such matter that may be properly disclosed.

I hereby certify that I have read, understood, and agreed to the Conflict of Interest Policy and that the information given in this statement is complete and accurate to the best of my knowledge.

I acknowledge that I have received and read the Lamaze International Advertising Standards. I understand that no advertising can be included in professional or consumer publications that contradict or do not support the mission of Lamaze International; and I agree that as a planner/presenter of Continuing Education provided for Lamaze Contact Hours, I will not accept advertising or promotions that may violate the Lamaze International Advertising Standards.
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