SAPCC Acting Representative In order for an Alternate (or other member in good standing from your S/A/P/C/C) to substitute for a Representative/Ambassador at either the ICES Representatives’ Breakfast and or Annual Representatives Meeting.: This form must be completed by the Representative/Ambassador and Named Acting Representative/Ambassador for the S/A/P/C/C. The Acting Representative must be from the same S/A/P/C/C. This form must be filled out completely and submitted to the Representative Liaison by June 15 for approval. Are You?* Representative/Ambassador Acting Representative Your InformationS/A/P/C/C Name* Please select your State, Area, Providence, Country or Chapter name.Name* First Last Phone*Primary contact numberAlt PhonePlease enter alternate phone number if applicable.Email* Enter Email Confirm Email 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 Representative/AmbassadorI Am Unable to Attend* The Annual Representatives Meeting I am Naming First Last Email* Enter Email Confirm Email As my Acting Representative/Ambassador. This entitles the named individual to exercise my voting rights as a Representative/Ambassador. It also entitles the named individual to receive appropriate travel reimbursement to which the Representative is entitled for this meeting, provided all conditions have been met and all required reporting is up to date and on file with the Representative Liaison for the Representative’s/Ambassador's S/A/P/C/C.Acting RepresentativeI Agree to Attend* The Annual Representatives Meeting Named Acting Representative By* Your SAPCC Representative/Ambassador Email* Enter Email Confirm Email Acting Representatives ContractThis entitles me to exercise the voting rights as a representative for the S/A/P/C/C named above. It also entitles me to receive the appropriate travel reimbursement provided all conditions are met and the required reporting is up to date and on file with the Representative Liaison for this S/A/P/C/C. I agree to provide the above referenced S/A/P/C/C with a written report of the activities of the Representative Meeting within 30 days from the close of the meeting. I understand that I must attend all four (4) sessions of the Representatives’ meetings in order to be eligible for full travel reimbursement or it will be adjusted accordingly.Contract Digital Signature Alternate Contract Signed By Checking Contract Digital Signature, I agree to the Acting Representatives Contract and all ICES responsibilities it implies. I AgreeI 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.