Managing Conflicts of Interests: Gifts and hospitality declaration form

To declare shareholdings, patents, loyalty interests, donations, outside employment and clinical private practice, sponsored posts, events or research - please use https://www.surveymonkey.co.uk/r/CRHDeclarationofInterest

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* 1. Full name

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* 2. Role

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* 3. Designation

Governor

Executive Board member

Non-executive Board member

DSFS Board Member

Medical

Non-medical

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* 4. Decision Maker (BoD, CoG, DSFS Board, consultants with management roles, agenda for change 8d and above, those directly involved in recruitment and those deemed as an 'authorised signature'.)

Yes

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* 5. Division (Governors and Non-Executive Directors please use Corporate Division)

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* 6. Permission to publish (please choose 'yes' unless there are exceptional circumstances; for example in doing so would risk harm.)

Yes

No - Please state the reason why