Local Unit Executive Confidentiality Agreement Form

As per HSAA policy, each member of the Local Unit Executive must complete a confidentiality agreement and conflict of interest declaration once they are elected to or hold a position within an HSAA Local Unit. Members can complete, sign and submit this agreement online using the form below.

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* Indicates required field

Local Unit & Position

Local Unit *

Local Unit Executive Position *

Please select the active position that applies for you. Note: If you hold more than one active position, use the other option in this list to trigger a manual entry field.

Explain other - list all active positions:

I am not currently an HSAA Board Member and/or understand that I must resign from any Board position to become a member of the Local Unit Executive. *

Please enter your initials below to acknowledge that you agree with the statement above.

Your Information

First Name *

Last Name *

HSAA Member ID *

Personal Email *

I understand that my personal contact information (above) will be shared with the Local Unit membership. *

Please enter your initials below to acknowledge that you agree with the statement above.