Declaration of interest (Board, Council, Advisory Group members)

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The details you provide will be emailed to Maha Jamil, Executive Assistant to the CEO and Board.

Full name (with designatory letters):

Current job title:

Nature of business:

Choose one of the following where appropriate:

Principal clients (defined as those with a financial relationship exceeding £10,000 per annum)Where such information is available (e.g. on company website)State that *such information is withheld(*If ‘information is withheld’ you are asked to advise the CEO on each occasion where a conflict may be perceived to arise)

List principal clients:

State where information is available:

Advise of potential conflicts:

Other Directorships / Trusteeships (including in other professional associations):

Please state any contractual arrangements existing with other CIPR Board / Council / Advisory Group members:

Please state any contractual arrangements made with companies or organisations known to supply services or products to CIPR or CIPR groups:

Please state any contractual arrangements or offices held with other industry or professional bodies including the PRCA, CIM, IoIC, IoD, PRSA, IABC or similar:

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