MAY 13
, 2011
Designation
of Proxy
If
a delegate to the Alumni Council is unable to attend,
this form must be returned with the name of the proxy
and the signature of the delegate authorizing this
action.
I
__________________________ hereby authorize _____________________________
Print Delegate Name Print Proxy Name
to represent me at the
May
13
, 2011
1
HUAA Alumni Council Meeting.
Delegate Information
Name
__________________________________________________________________
Position/Title
_____________________________________________________________
Daytime
Telephone____________________ Evening Telephone ___________________
Proxy Information (Must be a HUAA member
in good standing)
Name
__________________________________________________________________
Address
________________________________________________________________
City
____________________
State
__________________ Zip Code _______________
Daytime
Telephone___________________ Evening Telephone ____________________
Email
__________________________________________________________________
Signature
of Delegate _____________________________________________________
Date
___________________
