Free Board of Director Proxy Form

Board of Director Proxy Form
Please complete the details below and sign where indicated.
Shareholder Information
Name
Phone Number
Proxy Appointment
I, the undersigned, appoint the following individual as my proxy:
Name of Proxy
Proxy's Email
Proxy's Phone Number
Meeting Details
Date
Location
Proxy's Voting Authority
Please indicate whether your proxy has full authority to vote or if there are any restrictions.
Full Voting Authority
Limited Voting Authority
For limited voting authority, please specify restrictions
Shareholder's Name:
Date:
Thank you for your submission!
We appreciate you taking the time to submit.
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