Board Member Agreement and Conflict of Interest Form

Board of Directors

Name:

Stop Snoring Fast

*First*
*Last*

Email:
[Your Email Here]

Institution/Organization:
[Your Institution/Organization Here]

Role with AASM:
[Your Role Here]

In the past year, have you reviewed the current mission and vision statements?
– YES
– NO

In the past year, have you reviewed the current bylaws?
– YES
– NO

In the past year, have you reviewed the current policy manual?
– YES
– NO

If you answered “NO” to any of the questions above, please make sure to review the relevant documents before proceeding.

Signature:
*I certify that the information provided is accurate and I comply with the policies regarding Board Member Agreements.*

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Conflicts of Interest

Please respond to the following questions related to your roles on all Boards, Committees, Advisory Panels, and Task Forces you have been appointed to.

Definitions:

• Advisory Board: A group offering strategic advice to an organization, often referred to as a council or panel.
• Board of Directors: Elected individuals responsible for the organization’s strategic direction and oversight.
• Commercial Entity: For-profit organizations involved in the manufacturing or marketing of products and services.
• Consultant: An expert providing specialized advice.
• Healthcare Association: A nonprofit organization focused on healthcare, requiring dues for membership.
• Intellectual Property: Creative works or inventions, such as manuscripts, eligible for legal protections.
• Sleep Entity: Refers to sleep labs, facilities, or independent practices.
• Speakers’ Bureau: A collective of experts delivering information about a commercial entity’s offerings.

1. Are you directly employed or serving as a consultant for a commercial entity related to sleep with a total yearly non-investment income of $25,000 or more?
   – YES
   – NO
   If yes, please provide the company name, start date (month/year), and end date (month/year or current).
2. Are you directly employed or serving as a consultant for a commercial entity related to sleep with a total yearly non-investment income of less than $25,000?
   – YES
   – NO
   If yes, please provide the company name, start date (month/year), and end date (month/year or current).
3. If you have multiple conflicts, is the combined total yearly non-investment income from all listed conflicts $75,000 or more?
   – YES
   – NO
4. Do you or a close family member own more than 5% of a sleep-related commercial entity?
   – YES
   – NO
   If yes, please provide the commercial entity name, start date (month/year), and end date (month/year or current).
5. Are you an owner of individual stock in a sleep-related commercial entity?
   – YES
   – NO
   If yes, please provide the company name, start date (month/year), end date (month/year or current) and indicate if the value is $10,000 or more.
6. Have you accepted payments for speaking engagements from a commercial entity, excluding payments from unrestricted educational grants?
   – YES
   – NO
   If yes, please provide the commercial entity name, start date (month/year), and end date (month/year or current).
7. Have you received gifts or discounted/free use of materials or equipment from a commercial entity valued at $1,000 or more?
   – YES
   – NO
   If yes, please provide the company name, type of gift, start date (month/year), and end date (month/year or current).
8. Are you directly employed or serving as a consultant related to the establishment or accreditation of sleep entities?
   – YES
   – NO
   If yes, please provide the company name, start date (month/year), and end date (month/year or current).

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As we navigate our roles in the sleep community, it’s vital we stay informed about effective solutions for snoring and sleep issues. For instance, the Snorple anti-snoring mouthpiece has been shown to effectively reduce snoring from the very first night. Interested in learning more about how to use a stop snoring mouthpiece? Check out this guide for practical tips.

If you’re also curious about the impact of sleep on emotional well-being, our recent post on grieving and sleep dives deep into how our sleep patterns can be affected during tough times.

In addition, for those looking for expert information on the differences between snoring and sleep apnea, the resource at Sleep Apnea.org is an excellent read.

For more insights and information on mouthpieces to stop snoring, visit this resource.

Let’s keep our discussions open and engaging as we work together in the field of sleep medicine!