Proxy

Full Name *

I, (name as entered below), am a Member in Good Standing of the CBCA. I hereby consent that this proxy may be used solely for the purposes of establishing a quorum at Regular General Member meetings at which I am unable to be present, and for no other purpose.

This proxy shall expire at the end of the calendar year in which it signed, or sooner by written revocation.

Date *

Yes, I agree and affirm the above statement *

By checking the "Yes" box below, I acknowledge and agree that this action constitutes my electronic signature, and that it is legally equivalent to my handwritten signature. I certify that the information provided is true and complete to the best of my knowledge. I understand that my electronic acceptance is binding and carries the same legal weight as a signed, written document.