Register of Interests Form

    I, , in my capacity as a member of the Executive of the Epilepsy Nurses Association agree to uphold the Nolan Principles of:

    1. Selflessness
    Members of the executive should act solely in the interest of the membership and stake holders
    of ESNA.

    2. Integrity
    Members of the executive should avoid placing themselves under any
    obligation to people or organisations that might try inappropriately to
    influence them in their work. They should not act or take decisions in
    order to gain financial or other material benefits for themselves, their
    family, or their friends. They must declare and resolve any interests and

    3. Objectivity
    Members of the executive must act and take decisions impartially, fairly and
    on merit, using the best evidence and without discrimination or bias.

    4. Accountability
    Members of the executive are accountable to the membership for their decisions
    and actions and must submit themselves to the scrutiny necessary to
    ensure this.

    5. Openness
    Members of the executive should act and take decisions in an open and
    transparent manner. Information should not be withheld from the membership
    unless there are clear and lawful reasons for so doing.

    6. Honesty
    Members of the executive should be truthful.

    7. Leadership
    Members of the executive should exhibit these principles in their own
    behaviour. They should actively promote and robustly support the
    principles and be willing to challenge poor behaviour wherever it occurs.

    In the spirit of openness and honesty I list below relevant voluntary and pecuniary interests:

    Paid employment
    Please give details of:
    (i) every employment, office, business or vocation for which you receive any benefit or gain (i.e. profit, salary or benefit in kind)
    (ii) the name of any business which you own
    which might result in, or be viewed as causing, a conflict of interest in regards to your work for ESNA.

    Commissioned work or sponsorship
    Please give details of any body or person who has paid you a fee, commission, expenses or sponsorship in the last 12 months for advice, guidance, training or education directly related to your role as a epilepsy professional.

    Other bodies
    Please give details of significant roles you carry out within other professional or charitable epilepsy organisations or groups.