Proxy Authorization Form

Proxy Authorization Form

This is a form to authorize another to represent you at Eastsound Water Users Association Member meetings. This proxy grants authority to your designated proxy only if you are not personally in attendance at the Member meeting or do not vote.
The Terms of the Authorization

I am a Member of the Eastsound Water Users Association (the "Member") and, as of the date I have signed this Proxy Statement, appoint the below-marked individual, (the "Proxyholder"), with full power to act alone, as my agent, with full powers as a Member of the Eastsound Water Users Association, and with all capacities, to exercise all voting and related rights, with respect to all Membership Agreements in the Association held by me on the date I have signed this Revocable Proxy (this "Proxy").

This Proxy shall be in effect until the earlier of: (i) the one (1)-year anniversary of the Effective Date; or (ii) termination by written notice by the Member to the designated Proxyholder.

This Proxy only grants authority to the Proxyholder if: (i) I do not personally attend a Member meeting held on Orcas Island, WA; or (ii) I do not personally vote in an election where I am authorized to vote.

I also agree not to grant any proxies to other parties with respect to any Membership Agreements until after this Proxy expires.

I understand and agree that this Proxy shall be governed by, and construed in accordance with, the laws of the State of Washington. Any legal suit, action or proceeding relating to, arising out of, or arising under this Proxy shall be brought in the Superior Court of San Juan County, Washington; and each party irrevocably submits to the exclusive jurisdiction of such courts in any such suit, action, or proceeding.

I have listed my name, mailing address, Member Account Number(s), and Tax Parcel Number(s), including additional accounts I may hold which I understand constitutes a separate Membership and a separate Proxy in accordance with the Bylaws of the Eastsound Water Users Association. IN WITNESS WHEREOF, the undersigned Member of the Eastsound Water Users Association has executed this Revocable Proxy to be effective as of the date last set forth below.
We will complete some of the form for you if you type your account name in the following box. It must be in ALL CAPS, and it must be exactly as listed. You can see the list of Members to verify the spelling. You can copy and paste from that document into the open Account Name box.

List of Member Names

The member list shows only names. Know that the law requires EWUA to share the names of Members with other Members, along with their contact information and the number of votes each Member has. The Member's name, the tax parcel number (TPN), and the mailing address is also publicly available on the San Juan County website.

We do not autocomplete the phone number or email for you. Please add these yourself. Thus, we maintain your privacy in case someone else types in your name in an attempt to glean phone numbers or email addresses.

You may modify and correct the fields that we populate for you.
Each possible designated Proxyholder is committed to voting to recall:

Jim Nelson

Teri Nigretto

Mike Cleveland

Leith Templin

Any appointee made to the Board prior to or at any Member meeting.
I designate one of the following individuals as my first Proxyholder:*

Carol AndersonRon ClausJim CookTenar HallSteve Smith
I designate one of the following as my secondary Proxyholder should the first Proxyholder be unable to act on my behalf. (Please choose someone different than you have for your first Proxyholder.)*

Carol AndersonRon ClausJim CookTenar HallSteve Smith
If you type your account name in ALL CAPS exactly as it is shown in the above List of Member Names, then the fields such as TPN and Account number will auto fill.
Please type your EWUA Account Name in ALL CAPS. Check the List of Member Names (link above) to verify spelling and punctuation. For auto complete to work, it must match exactly.
Name*
Mail Address 1*
Mail Address 2
City*
State*
Zip*
Please verify or add the Tax Parcel Number (TPN), Account Number, and Service Address for each parcel for which you have a Membership.

Please correct any errors that we have in our records. You can modify the autofilled fields.

I have the authority to grant a proxy for the Memberships associated with the following TPN(s).
TPN1*
Acct#1*
Service Address 1*
TPN2
Acct#2
Service Address 2
TPN3
Acct#3
Service Address 3
TPN4
Acct#4
Service Address 4
TPN5
Acct#5
Service Address 5
Phone Number*
This number may be used to verify that you have signed the form. Your number will not be used in any other way unless you ask us to keep you updated or if we see a problem with your form.
Email*
This address may be used to verify that you have signed the form. Your email address will not be used in any other way unless you ask us to keep you updated or if we see a problem with your form.
Do you wish to receive updates on the recall and meeting dates? Mark all that apply.*

Yes - via text at the number listed aboveYes - via emailNo
Do you want to be listed as a supporter of the recall effort on the RecallWater.com - Who We Are page?

YesNo
Were corrections made to the prefilled form?

YesNo
Signature*

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Your "printed" name
Date

MonthDayYear
Date
You may contact us at recallwater@gmail.com if you have any comments or questions.
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