S/A/P/C/C Reps Moderator Nomination/Acceptance Form S/P/A/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 Nominate/Accepting/Decline* Nominating Accepting Decline Are you nominating or accepting the position of ModeratorI would like to nominate Nominees Name* First Last Name of person to be nominatedto be a candidate for ICES Representative Moderator for the coming year.Nominee's Email* Enter Email Confirm Email Email address of Nominee Candidates Name* First Last Your Nameto be a candidate for ICES Representative Moderator for the coming year.Qualifications* Select All Previous Board of Director Previous Representative or Representative Liaison Working knowledge of Robert’s Rules of Order Working knowledge of ICES Bylaws and am willing to seek out answers Frequent participant at past Midyear and Convention Meetings Legible handwriting Personable and disciplined Very organized and professional I have the following qualification for the positionRepresentative Moderator ContractI, having been elected, or appointed by the Representative Liaison, to the position of Representative Moderator of ICES for the term, accept the responsibilities to help lead our members and support our organization. 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, attending bi-monthly Representatives Webinars, and to assist the Representative Committee in the planning of the Annual Representatives Meetings. I will take these duties seriously; I will follow directives from the Board of Directors, and will act on Board suggestions to the best of my ability. As Representative Moderator I will chair the Annual Representatives Meetings of the S/A/P/C/C Representatives & Ambassadors. I will conduct all meetings in a precise and proper manner compliant with this position, maintaining the orderly business of the Representatives, and I will follow the procedures of the ICES organization and meeting procedures as stated in Robert’s Rules of Order, Newly Revised, latest edition. As Representative Moderator, I understand that I am eligible for reimbursement for attending the Annual Representatives meeting, subject to the full attendance at said meeting, and in accordance with the rates set forth by the Board of Directors.Digital Signature* I Accept If elected as the Representative Moderator. I agree to perform my duties as described in the Representatives Moderator's Job Description and to conduct the Annual Representatives Meeting in an orderly manner.Date* MM slash DD slash YYYY 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).Decline* I Decline I respectfully decline the position of Representative Moderator at this time for the coming year.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).NameThis field is for validation purposes and should be left unchanged.