Name

Title

Municipality

Board Title

President President-Elect DVP

Department Rep. Ex-Officio

Mailing Information

Work Email Address

Personal Email Address

Do you prefer we contact you at your work email address or personal email address?

Work email is best

Home email is best

Work Phone

Personal Phone/Cell

Personal Information

Birth Month/Day

Nickname

Occupation

Partner's Name (if applicable)

Please list any dietary needs

Emergency Contact

Emergency Contact Relationship

Emergency Contact Phone Number

Other Information

Your Next Election Date (month and year)

Please list your favorite issues areas

Personal Interests & Hobbies

Close Personal Relationships with State/Federal Leaders

MML Board of Directors Conflict of Interest Policy and Disclosure

Members of the Maryland Municipal League Board of Directors (the “Board”) must act at all times in the best interests of the League. The purpose of this policy is to help inform the Board about what constitutes a conflict of interest, to assist the Board in identifying and disclosing actual and potential conflicts, and to help ensure the avoidance of conflicts of interest where necessary. This policy shall be implemented as follows:

1. Board members have a fiduciary duty to conduct themselves without conflicts of interest. In their capacity as Board members, they must subordinate personal, individual business, third-party, and other interests to the welfare and best interests of the League.

2. A conflict of interest is a known transaction or relationship which presents or may present a conflict between a Board member’s obligations to the League and the Board member’s personal, business or other interests, including their duty to the League Member of which the Board member is an elected or appointed official or an employee.

3. All conflicts of interest are not necessarily prohibited or harmful to the League. However, full disclosure of all actual and potential conflicts, and a determination by the Executive Committee– with the interested Board member(s) recused from participating in debates and/or voting on the matter – are required.

4. All actual and potential conflicts of interests shall be disclosed by Board members through the annual disclosure form and/or whenever a conflict arises. The disinterested members of the Executive Committee shall make a determination as to whether a conflict exists and what subsequent action is appropriate (if any). The Executive Committee shall inform the Board of such determination and action. The Board shall retain the right to modify or reverse such determination and action, and shall retain the ultimate enforcement authority with respect to the interpretation and application of this policy.

5. On an annual basis, all Board members shall be provided with a copy of this policy and required to complete and sign the acknowledgment and disclosure form below. All completed forms shall be provided to and reviewed by the Executive Committee, as well as all other conflict information provided by Board members.

I have read the Maryland Municipal League’s Conflict of Interest Policy set forth above and agree to comply fully with its terms and conditions at all times during my service as a Board Member. If at any time following the submission of this form I become aware of any actual or potential conflicts of interest, or if the information provided below becomes inaccurate or incomplete, I will promptly notify the President of the Board in writing.

No, I am not aware of any actual or potential conflicts of interest

Yes, I am aware of actual or potential conflicts of interest

Disclosure of Actual or Potential Conflicts of Interest

Board Member Electronic Signature (please type your name in lieu of signature)

Today's Date

MML Board of Directors Service Commitment Pledge

In recognizing the important responsibility I am undertaking in serving as a member of the Board of Directors of MML, hereby pledge to carry out in a trustworthy and diligent manner the duties and obligations in my role as a board member.
My Role:
I acknowledge that my primary roles as a board member are (1) to contribute to defining the organization’s mission and governing the fulfillment of that mission, and (2) to carry out the functions of the office of Board Member and/or Officer as stated in the bylaws.
My role as a board member will focus on the development of policies that govern MML. This role is separate and distinct from the role of the staff, who determine the means of policy implementation.
My Commitment:
I will exercise the duties and responsibilities of this office with integrity, collegiality and care.
I Pledge:
• To establish as a high priority my attendance at all meetings of the board and committees on which I serve.
• To be prepared to discuss the issues and business addressed at scheduled meetings, having read the agenda and
all background material relevant to the topics at hand.
• To work with and respect the opinions of my peers who serve the board and to leave my personal interests out of
all board discussions.
• To always act for the good of MML.
• To represent MML in a positive and supportive manner at all times and in all places.
• To observe parliamentary procedures and display courteous conduct in all board and committee meetings.
• To refrain from intruding on administrative issues that are the responsibility of staff, except to monitor results and
prohibit actions that conflict with board policy or the law.
• To avoid conflicts of interest between my position as a board member and my personal life. If such a conflict does
arise, I will declare that conflict and refrain from voting on matters in which I have a conflict.
• To support in a positive manner all actions taken by the Board of Directors even when I am in a minority position
on such decisions.
If, for any reason, I find myself unable to carry out the above duties, I agree to resign my position as a board member.

Board Member Electronic Signature (please type your name in lieu of signature)

Today's Date

Board Member Goals

I wanted to become a member of MML's leadership team because

I want to personally accomplish

List one new program or service you would like to see MML offer its members. Explain why this would be of benefit to the membership