Delegate Nomination and Consent Form

I wish to be consider nominated and do hereby consent to serve if elected as:

Third Delegate

First Alternate

Second Alternate

For the year of

to

I assert that I will fulfill my duties as stated below. At this current time there is nothing preventing me from serving in this honored position (i.e. good health, personal affairs, job obligations). I understand that should I not be able to fulfill my role as a delegate and if I have incurred expenses, it is my responsibility to seek out refund of those expenses from appropriate vendor and that TSMA is not responsible for those expenses incurred. If I have received any reimbursements from TSMA for conference expenses including travel and registration, that I will be responsible for repayment to TSMA.

Signature of Nominee

Please type your full name to represent your signature.

Date

I understand that my duties as a delegate/alternate delegate will include (Please check each one.)

Please check all.

As soon as I am elected will request from my employer the appropriate time off for the AAMA Annual Conference.

Actively participate in any TSMA Meeting during my term to assure that I am informed of issues within the society and that I am informed of the desires of the TSMA/AAMA membership.

I understand that by signing up to serve as delegate I am consenting to serve on the TSMA By-Laws Committee for my term as delegate.

I understand that my term as a delegate or alternate will be from AAMA Conference to AAMA Conference per the AAMA By-Laws.

Communicate with all other delegates to assure that travel arrangements and rooming arrangements are made as early as possible (i.e. Delegates should room with each other; coordinate transportation to/from airport together.) I understand that I am responsible for my own travel arrangements. I will request reimbursement from TSMA with a legible photocopy of the receipt along with TSMA Reimbursement form within the 21 days of the close of conference. I understand that reimbursement will include my Delegates report must be submitted prior to reimbursements being sent.

Registration will be paid by TSMA.I will submit my Registration Form to the TSMA Treasurer by July 1st. I understand that should I need to cancel my attendance to conference that I will need to request reimbursement from AAMA for TSMA and repay any difference in the total registration if necessary.

During the AAMA Conference will attend any meeting that my State President/First Delegate requests TSMA Delegation to attend, including Delegate Orientation (regardless of previous attendance), the Awards Banquet and Presidents Luncheon. Reach out to other Texas attendees to assure that they are invited/included to sit with delegation at all events.

I will communicate with TSMA president about any changes or concerns regarding my attendance to AAMA Conference.

Name of Nominee

Telephone

Preferred Address

City

State

Zip

Email Address

Employer

Briefly state occupational duties

Leadership Roles: (includes offices held, chairmanships, committee memberships)

Chapter

TSMA

Non-TSMA/Community

List previous years of service as a delegate/alternate to the AAMA Conference.

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TEXAS SOCIETY OF MEDICAL ASSISTANTS AAMA DELEGATE AND ALTERNATE NOMINATION AND CONSENT FORM

TEXAS SOCIETY OF MEDICAL ASSISTANTS AAMA DELEGATE
AND ALTERNATE NOMINATION AND CONSENT FORM