Board Election Proxy Form
Submit your proxy authorization and voting instructions for the upcoming board election.
Full Name of Shareholder or Member Granting Proxy
*
First Name
Last Name
Email Address of Shareholder or Member
*
example@example.com
Name of Proxy Holder (Person Authorized to Vote on Your Behalf)
*
First Name
Last Name
Date of Board Election Meeting
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Voting Instructions (Candidates, Motions, or General Direction)
*
Signature of Shareholder or Member
*
Submit Proxy
Submit Proxy
Should be Empty: