Meeting Proxy Authorization Form
Authorize a representative to attend and act on your behalf at a specified meeting.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Proxy's Full Name
*
First Name
Last Name
Proxy's Email Address
*
example@example.com
Proxy's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Meeting Name or Subject
*
Meeting Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Meeting Location
*
Relationship to Proxy
*
Please Select
Colleague
Family Member
Friend
Legal Representative
Other
Scope of Proxy Authorization (please specify any limitations or instructions)
Signature of Authorizing Person
*
Submit Authorization
Submit Authorization
Should be Empty: