SWSD 2013 Program Handbook November 2013 | Page 151

[SAMPLE]

VotingProxyForm
for
Southwest Suburban Dallas Chapter
of
Jack and Jill of America, Inc.
Please read carefully before assigning your proxy vote.
This is to certify that I, the Assignor, a voting officer/member on/of the
Executive Committee/Southwest Suburban Dallas Chapter of Jack and Jill of
America, Inc. (the “Chapter”), hereby designate the Authorized Assignee named
below as my representative to cast all votes and express all approvals or
disapprovals that I am entitled to cast or express at the ____________ Meeting
scheduled to be held on _______, at _____ CDT. In no event shall this proxy be
valid for any time after _________am/pm CDT (circle one) on ______________, 20__
(date).
This proxy shall be revocable, at any time, upon my execution and proper
submission3 of the Proxy Revocation below.
I also acknowledge by my initials, each of the following:
________ I am an active member/officer in Good Standing with the Chapter
________ I understand that Article IX of the Chapter Bylaws provides that:
A.
B.

Unless specifically noted (in the Bylaws), a Member’s vote may be cast via any of the
following methods: in person, voice, rising, show of hands, balloting, phone, email, online
survey, absentee, or proxy.
Exceptions to A above shall be as follows: the voting methods of in person, voice, rising,
show of hands, and balloting are the only methods that may be employed when casting votes
for new officers, new members, or bylaw amendments.

_______ This proxy form has been provided to me by the Chapter Parliamentarian, as
approved by the Bylaws Committee. It is intended to be submitted to the Chapter
Parliamentarian or the Chapter Sergeant-at-Arms as an original form bearing my
original ink signature. I have also provided my sample signature4 to the
Parliamentarian for verification of my signature below.

Proper submission requires that the revocation be submitted to the Chapter Parliamentarian or the Chapter
Sergeant-at Arms as either 1) an original form bearing an original ink signature or 2) a verbal
revocation made directly to either of the aforementioned officers.
4 Said sample signature will be collected at the beginning of the Program Year or requested at the time that the
Voting Proxy Form is sent to the Assignor. NOTE: For security purposes, your sample signature does
not have to be an “official” signature (used with banks, on tax forms etc), but it must match the
signature that is used on this form.
3

B-56

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