SWSD 2013 Program Handbook November 2013 | Page 152

_______ I understand that this Voting Proxy Form must be dated and signed to be
valid.
______ The Authorized Assignee is a Officer/Member in Good Standing [and/or a
member of the Executive Committee] of the Chapter.
NOTE: The Authorized Assignee (proxy-holder) must present the proxy form
for verification when she checks into the Executive Committee meeting with
either the Sergeant-at-Arms or the Parliamentarian who will compare the
Assignors signature below to the official version kept on file for such purposes
(signatures must match). The Chapter Parliamentarian or the Chapter
Sergeant-at-Arms have sole authority to verify the signature and confirm the
Authorized Assignee’s right to exercise the proxy.
______ I, the undersigned, have read, understand, and agree to the terms in the
NOTE above.
Authorized Assignee:
______________________________________
Print Name – Primary
_______________________________________
Print Name - Alternate
Assignor (ink only):
Signature__________________________________
Print Name: _______________________________
Print Office: ________________________________
Execution Date: ____________________________
Proxy Revocation (ink only):
Assignor’s Signature:_____________________________________________
Print Name: _______________________________________________________
Date:_______________________ Time: __________ am/pm (circle one)
Verbal revocations may be made to Tonya Tarpeh, Parliamentarian at 469-3372988 or Denise Wall, Sergeant-at-Arms at 972-467-5720.
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