2015 NAACCR Business Meeting Voting Proxy

The NAACCR Business Meeting will take place during the NAACCR Annual Conference. If you are unable to attend the meeting please assign a representative from your organization who will be attending the meeting to vote on your behalf. A proxy delegate must be designated in advance to vote on behalf of the member organization. The proxy delegate must be:

an employee or member of the NAACCR member organization
physically present at the NAACCR business meeting
submit the following electronic form to NAACCR

The assignment of a proxy will be in effect for this Annual Conference only. To permanently re-assign the Voting Delegate for your organization please contact the NAACCR office at 217-698-0800 to request the change.

1. Name of Member Organization: *This question is required.

2. Voting Member on Record

Full Name *This question is required.

Email *This question is required.

Phone Number *This question is required.

3. Change to Proxy Voting Member

Full Name *This question is required.

Email *This question is required.

Phone Number *This question is required.

4. Date of Submission *This question is required.

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5. By clicking YES below a new field will pop up. Please insert your full name in the box that will appear below after you check YES. This will certify that you are the NAACCR Voting Member on record for your organization and have the authority to assign voting privileges to the individual listed as the voting proxy. *This question is required.

Insert Full Name of Voting Delegate on Record *This question is required.