Valley Chapter - Official Proxy Submission

Official Proxy - Submission Form

A Proxy may only be issued to an eligible active PORAC member from a different eligible active member association. You may not issue a proxy to a member of your own association.
First Name* Last Name* , as an Active PORAC member, has been authorized by Association Name* to cast votes on behalf of our association at the Date* meeting of the Valley Chapter as designated below.
Type of Proxy

Your proxy will only be permitted to cast votes, on your association's behalf, based upon the type of proxy you are issuing.
- Limited Proxy: By selecting "Limited Proxy", you are required to provide the specific agenda items that you are authorizing your proxy to cast votes, on your behalf.
- General Proxy: By selecting "General Proxy" you are authorizing your proxy to cast votes, on your behalf, on any agenda items that are presented for vote.
What type of proxy is being given?
*Limited Proxy Only
Please list the specific agenda items for which your authorized proxy will be permitted to cast votes, on behalf of your association.
I, First Name* Last Name* , am currently the president of Association Name* and authorize this proxy.
Email
example@example.com
Date Proxy Authorized:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty: