FREE Proxy Form

By | November 11, 2011


This is to certify that the undersigned, a voting member of
[organization]   , has designated [whomever designated]
as his or her representative to cast all votes and express
all approvals or disapprovals that said member may be
entitled to cast or express at the annual meeting of [name
of group], to be held on       [date], and any lawfully
adjourned meetings thereof, and for all purposes provided by
the Articles of Incorporation, the By-Laws and the annual
meeting call of [organization].

In no event shall this proxy be valid for a period longer
than    days after the first meeting for which it is given.

This proxy shall be revocable, at any time, at the request
of the undersigned voting member.