ICBA Federal Delegate Board Nominating Form Contact Information Question Title * 1. First name Question Title * 2. Last name Question Title * 3. Job title Question Title * 4. Email address Question Title * 5. Cell phone number Question Title * 6. Date of birth Select Date Question Title * 7. How many years have you been a banker? (Whole number only) Question Title * 8. Confirm your eligibility to serve on the Federal Delegate Board by verifying that you are an Executive Officer of a paid Active Member Bank of ICBA. (The term Executive Officer of an Active Member Bank shall be defined as set forth by the Board of Governors of the Federal Reserve in Regulation O.) Yes No Question Title * 9. ICBA's general purposes and guiding principles are: Preserve fair competition in financial services Support the separation of banking and commerce Oppose concentration of economic and financial services resources Believe in a balanced financial system Support the dual banking system Create symbiotic relationships with our communities Favor local decision making Adhere to the highest business practices and ethical standards Support a democratically governed association where each member bank has a voice and a vote Do you understand? Yes, I understand. Question Title * 10. This is a three-year term and ICBA delegates will: Be the official representative of the ICBA in my state or district; Provide liaison between my state or district and the ICBA; Provide liaison between the ICBA and the local Affiliate Member State Banking Association; Keep the ICBA informed of my Congressman or Senators’ positions on community banking issues; Advise the ICBA of developments in my state of interest to community bankers; Promote membership in the ICBA within my state or district; Promote the ICBA’s products and services and its political action committee; Attend all meetings of the Federal Delegate Board; Make every effort to work in close cooperation with the state community banker organization if there is such an organization within my state; Attend the state community banker convention and all meetings of the state community banker association when invited; and Adhere to the duties and responsibilities as stated in the ICBA Federal Delegate Board guidelines. Do you understand? Yes, I understand. Question Title * 11. Furthermore, do you understand that you are subject to removal if you fail to fulfill the above duties; accept an appointment or are elected to a leadership position that has fiduciary responsibility with a non-affiliated competing state or national financial services association; your bank should become subject to a regulatory sanction; or if any of the above information should materially change.Do you understand? Yes, I understand. Continue