S/A/P/C/C Representative Contract TESTING SAPCC Representative Contract (1) Welcome to the Representatives Contract page. This form must be submitted annually by September 1st.This form will not be complete until all required fields are filled in and the submit button at the bottom of the form is submitted.All fields marked with an * are required.Please contact the Representatives Liaison at “email@example.com” with any questions or form issues. Your InformationS/A/P/C/C Name*Please select your State, Area, Providence, Country or Chapter name.Your Name* First Last Phone*Primary contact numberAlt PhonePlease enter alternate phone number if applicable.Email* Enter Email Confirm Email S/A/P/C/C Email Address?*--- Please Select ---NoYesS/A/P/C/C Email* Enter Email Confirm Email Preferred ICES email address for correspondence.*Personal email addressS/A/P/C/C email addressRepresentative's Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Photo*Accepted file types: jpg, png, jpeg.Please upload your High Quality Photo in JPG or PNG here. A current Head shot must be submitted with this form. Maximum Upload Size 5 MB.Biography Upload*Please attach a Biography (BIO) of yourself in PDF format. A current Bio must be submitted with this form. Maximum Upload Size 5 MB.Representatives ContractI, having been elected, or appointed by the Representative Liaison, to the position of Representative of ICES for the State/Area/Province/ Country/Chapter (S/A/P/C/C) stated above, accept the responsibilities to help lead our members and support our organization. It shall be the duty of the Representative to preside at meetings of the S/A/P/C/C, appoint committees, as necessary, and perform the duties of Representative as outlined in the Representative’s Responsibilities in Detail. The Representative shall maintain copies of all minutes, ICES Board of Director's correspondence, and other correspondence deemed necessary by the Representative. Financial records shall be kept for a minimum of seven (7) years. Copies of all newsletters shall be sent to the ICES President, Representative Liaison, Newsletter Editor, and Board Liaison. All S/A/P/C/C property is to be delivered to the incoming Representative. It shall be the responsibility of the Representative to file the semiannual reports in accordance with the deadline set by the ICES Board of Directors. By accepting this position, I am committing myself to serve this organization to the best of my ability. I further agree to support and promote the organization by being an active member, including participating in meetings and attending the annual conventions, if possible. I will take these duties seriously. I will follow directives from the Board of Directors and act on Board suggestions to the best of my ability. As a Representative, I will keep my ICES membership current during my term, I will set up and hold a minimum of two “ Days of Sharing” or “ Meetings of the S/A/P/C/C Members of ICES” per year to share with the members in my S/A/P/C/C all information concerning local and national meetings, classes available in our area, new methods and new materials, in a way that promotes ICES to its fullest. As a Representative, I will follow the Bylaws for my S/A/P/C/C. Provided all conditions stated above have been met and required reporting is up to date and on file with the Representative Liaison, the following monies may be requested from ICES: A travel reimbursement for attending the Annual Representatives Meeting, subject to the full attendance at the meeting, in accordance with the rates set forth by the Board of Directors. *** A current Headshot and Bio must be submitted with this form ***Contract Digital Signature* Representatives Contract Signed By Checking Contract Digital Signature, I agree to the Representatives Contract and all ICES responsibilities it implies. I Agree* Digital Signature By clicking “I agree”, I agree to use an electronic signature to demonstrate my acceptance of the above information. I understand and agree that an electronic signature and/or electronic acceptance is as legally binding as an ink signature. Al hacer clic en "Acepto" acontinuación, acepto usar una firma electrónica para demostrar mi aceptación dela información anterior. Entiendo y acepto que una firma electrónica y / oaceptación electrónica es tan vinculante como una firma de tinta. This form is not complete unless you click “submit" and will be used as your digital signature. Once you have submitted the form you should receive a “Thank You” confirmation email. If you do not receive this “Thank You” email then your form DID NOT go through and you will need to RE-SUBMIT your form. Please double check to make sure you: Have filled in all the required information, (a RED message will appear if information is missing).Este formulario no está completo a menos que haga clic en "enviar".Una vez que haya enviado el formulario, debe recibir un correo electrónico de confirmación de "Gracias". Si no recibe este correo electrónico de "Agradecimiento", entonces su formulario NO se envió y tendrá que REITERAR su formulario.Por favor, vuelva a verificar para asegurarse de que:Ha completado toda la información requerida (aparecerá un mensaje ROJO si falta información).PhoneThis field is for validation purposes and should be left unchanged.