Designation of Proxy
 

Howard University Alumni Assocation

If a delegate to the Alumni Council Meeting is unable to attend, this form must be returned with the name of the proxy and the signature of the delegate authorizing this action by May 4th, 2014.



I (Delegate Name): hereby authorize (Proxy Name):

to represent me at the May 9th, 2014 Alumni Council Meeting.

Delegate Information


First Name:

Middle Initial:

Last Name:

Position/Title:

Daytime Telephone#: Evening Telephone#:

Email Address:

Proxy Information (Must be a HUAA member in good standing)


First Name:

Middle Initial:

Last Name:

Position/Title:

Street Address 1:
Street Address 2:
City: State/Province:

Zip Code: Country:

Daytime Telephone#: Evening Telephone#:

Email Address:

Initials of Delegate :

Additional Comments: