APPLICATION FOR ICC Codes & Standards Committees

APPLICATION FOR ICC Codes & Standards Committees

This form is available at http://www.iccsafe.org/membership/councils-committees/icc-committee-application/

It is important to complete all of the questions on this form, supply additional requested information, sign and date the application. This application can be used to apply for membership on any ICC Codes & Standards Committee or Council. If you apply to be on more than one committee in Part I – #1 below, and if your participation will be funded by separate sources (entities), you must submit separate applications for each committee/funding source. Be sure to review the posted “Call for Committees” at http://www.iccsafe.org/membership/councils-committees/call-for-committees/ to determine which committee(s) or council(s) are considering new applications and the deadline for submittal of the applications.

Important: Complete all of the questions on this form, supply additional requested information, and sign and date the application.

Part I. General Information

Important: Complete all of the questions on this form, supply additional requested information, and sign and date the
application.

Fields marked with an * are required

Part I. General Information

1. Name of ICC Committee(s) or Council(s) on which you would like to be a member:

(See list on Page 5 of this Page for reference – Indicate the acronym for the Committee or Council and list in order of preference.)

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2. Applicant Information: Complete the following information on yourself.

Entity Represented: Complete the following information on the entity you represent (Jurisdiction, Company, Association, group, or yourself).

(check one) Using the Interest Categories listed on the next page, indicate the Interest Category that best relates to your representation.

(check one) Using the Interest Categories listed on the next page, indicate the Interest Category that best relates to your representation.

Voting Status Indicate if you will be the voting Principal or Alternate. (Alternates must represent the same entity as the Principal. Alternates are not appointed for members of an ICC Code Committee.)

Principal name:

Important: Complete all of the questions on this form, supply additional requested information, and sign and date the application.

Part I. General Information

Part II. Authority and Funding

(Appropriate authorization may be required.)

Important: Complete all of the questions on this form, supply additional requested information, and sign and date the application.

Part I. General Information

Who or what organization, company, interest, etc., funds your participation? (see below)

All funding sources must be divulged

NOTE: If you have applied to be on more than one committee, and if your participation will be funded by separate sources (entities), you must submit separate applications for each committee/funding source. If you will NOT be representing or funded by an outside entity (organization, company, etc.), and are applying as an individual member and funding your own participation on the Committee, simply state “Self” below.


Note: ICC Governmental Members are typically authorized to travel at ICC’s expense for C&S related committees. Be sure to review the “Call for Committee” to determine ICC’s travel policy for the specific committee for which you are applying.

Important: Complete all of the questions on this form, supply additional requested information, and sign and date the application.

Part I. General Information

Part III. Background and Experience

Please complete the following. Attach resume or additional sheets as necessary.

File type should be jpg,jpeg,gif,png,pdf,doc,docx,xls,xlsx,rtf,txt.

Maximum file size 5MB.

File Name:

File Size:

Date or Years of Service Organization / Committee
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Important: Complete all of the questions on this form, supply additional requested information, and sign and date the application.

Part I. General Information

Part IV. Additional Information

(Attach additional sheets as necessary.)

Important: Complete all of the questions on this form, supply additional requested information, and sign and date the application.

Part I. General Information

Part V. Certification and Agreement

Considerable effort, devotion and hard work will be expected of each Committee member. Committee membership carries an obligation to participate actively in all work of the Committee including the contribution and generation of information, prompt reply to draft reports and ballots, attendance and participation at Committee meetings and prompt completion of assigned tasks. The undersigned hereby agrees to notify the International Code Council of a change in any of the information provided in this application including a change in the organization represented, source of funding or employment. The undersigned agrees to abide by the rules and policy of the International Code Council. The undersigned attests that the information provided in this application for Committee membership is true and accurate.
The undersigned hereby agrees that his or her authorship contributions to ICC in connection with work performed as a member of an ICC committee are considered to be works made for hire for ICC. To the extent that the undersigned retains any rights in copyright as to such authorship contributions, the undersigned hereby grants and assigns to ICC all such rights. The undersigned understands that he or she will have no rights in any ICC publications that use such contributions by the undersigned and certifies to the best of his or her knowledge that such contributions are not protected by the copyright of any other person or entity.

By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

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