REGION/CHAPTER PROXY

REGION/CHAPTER PROXY

USAWOA FORM 300-17
REGION PROXY FORM
To ensure we have a quorum for any region meeting, please follow these steps to complete the proxy form:

Enter Your Personal Information:

Fill in your full name, membership ID, and contact details in the designated fields.
Name*

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Membership Number
Select Your Region Proxy-Assignee:

You have two options for assigning your proxy:

Option 1: Choose any member in good standing within your region.
Enter the full name of your chosen proxy-assignee in the provided field.

Option 2: Keep the default selection.
If you prefer, you can keep the default option of "Region director (or representative)." No additional action is required if you choose this option.
I hereby appoint Region Proxy-Assignee* as proxy holder with full power to vote for and on behalf of the undersigned at any scheduled meeting of this chapter.
This proxy will remain in effect as long as I am a member of the Chapter or until revoked by me.

In the event that I am present for a Chapter meeting, this proxy is invalid for that meeting.
Additional instructions
Date*

MonthDayYear
Date
Member Signature*

Clear
CHAPTER PROXY FORM
To ensure we have a quorum for any region meeting, please follow these steps to complete the proxy form:

Enter Your Personal Information:

Fill in your full name, membership ID, and contact details in the designated fields.
Name

First NameLast Name
Membership Number
Phone Number
Please enter a valid phone number.
Email
example@example.com
Select Your Chapter Proxy-Assignee:

You have two options for assigning your proxy:

Option 1: Choose any member in good standing within your region.
Enter the full name of your chosen proxy-assignee in the provided field.

Option 2: Keep the default selection.
If you prefer, you can keep the default option of "Chapter president (or representative)." No additional action is required if you choose this option.
I hereby appoint Chapter Proxy-Appointee* as proxy holder with full power to vote for and on behalf of the undersigned at any scheduled meeting of this chapter.
This proxy will remain in effect as long as I am a member of the Chapter or until revoked by me.

In the event that I am present for a Chapter meeting, this proxy is invalid for that meeting.
Additional instructions
Review Your Information:

Double-check all entered information to ensure accuracy.

Date and Sign
Date*

MonthDayYear
Date
Member Signature*

Clear
Should be Empty:

REGION/CHAPTER PROXY

REGION PROXY FORM

CHAPTER PROXY FORM