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2008 Executive Committee Meeting- Proxy

SEPTEMBER 27 , 2008

Designation of Proxy 

If a delegate to the Executive Committee 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 September 27 , 2008 HUAA Executive Committee 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 ___________________

Please return this form to:

Howard University
Department of Alumni Relations
607 Howard Place, NW
Washington, DC 20059
Fax: (202) 667-0839