Proxy Voting Form - Rac-G printable pdf download

Proxy Voting Form - Rac-G

Piney W oods R egional A dvisory C ouncil

Trauma S ervice A rea G

Voting P roxy F orm

Current R AC-‐G V oting M embers m ay v ote b y g iving w ritten p roxy t o

any m ember w ithin t heir C ounty/Entity/Provider t o v ote

during a R AC-‐G G eneral A ssembly M eeting.

The p roxy s hould b e i ssued b y l ateral p osition, e .g. P hysician t o P hysician, H ospital

Representative t o H ospital R epresentative a nd E MS R epresentative t o E MS R epresentative.

_____________________________________

(Please p rint n ame o f P roxy H older)

from _ _____________________to v ote i n m y p lace a s m y p roxy

on a ll m atters w hich a re s ubject t o v oting b y p roxy t hat m ay c ome

before t he m embership a t t he G eneral A ssembly M eeting h eld

____________________________ ( date o f m eeting).

_____________________________________

( Voting M ember) Y our N ame _ ____________________________________

Hospital/EMS P rovider/Physician

_______________________________________

Date

Please f ax t his f orm t o R AC o ffice a d ay b efore t he d ate o f G eneral A ssembly M eeting.

Fax # 9 03-‐593-‐5092 o r s end a s a n a ttachment t o e mail t o

o ne d ay p rior t o

meeting. I f e mergency i s c ause f or n on-‐attendance, a s igned p roxy f orm m ay b e p resented a t t he

Registration D esk o n t he d ay o f t he m eeting.

File: F ORMS/PROXY

Proxy Voting Form - Rac-G