**Template Instructions (Delete before publishing)**
- Replace all placeholders with correct information:
- Name of Association
- Year
- Month, Date, Year of Meeting
- Time of Meeting
**Template Instructions (Delete the stars and everything above before publishing)**
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NAME OF ASSOCIATION
YEAR ANNUAL MEETING
Month, Date, Year of Meeting
UNINSTRUCTED PROXY BALLOT
USE THIS FORM IF YOU ARE UNABLE TO ATTEND THE MEETING TO VOTE IN PERSON.
I/We, and , of , being a member/members in good standing of Name of Association, do hereby grant my/our proxy for the sole purpose of voting at the YEAR Annual Meeting as follows:
Proxy Vote:
This proxy is executed for the YEAR Annual Meeting schedule for Date, at Time or any adjournments or continuations thereof. This proxy must be signed below in order to be valid.
PROXY INSTRUCTIONS
- A proxy may be revoked only by written notice from the owner(s) to the person presiding at the meeting.
- Type your name and address where indicated at the top of this proxy form.
- Any proxy shall be void if it is not signed and submitted, if it purports to be revocable without notice, or if the signature of any of those executing the proxy is invalid.
SIGN AND SUBMIT YOUR COMPLETED PROXY BY 12:00PM ON DAY, DATE, YEAR.
Signed Date:
