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 April 30th, 2012.
I (Delegate Name): hereby authorize (Proxy Name):
to represent me at the May 11th, 2012 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)
Street Address 1: Street Address 2: City: State/Province:
Zip Code: Country:
Initials of Delegate :
Additional Comments:
