2019 USAT AGM Proxy Form

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This form indicates the below person is authorized to vote for you at the upcoming USAT AGM. Fill this out if you will not be able to attend the 2019 USAT AGM (Monday, 20 Jan 2020, via teleconference). You and your proxy must be the designated representative of your club and in good standing with the USAT. You can view the designated representative and contact email for a club at https://www.usa.rugby/membership-resources/public-rosters/

This form closes at 3 PM EST, Mon 20 Jan.

Absentee Name *

Please give your full name. You must be the designated representative of your club.

Absentee Email *

Please give your contact email. If this is different than the email you've registered via USAR's webpoint portal, we will verify your identity with that email.

Proxy Name *

List the full name of the person who you are authorizing to vote for you at the AGM. This person must be the designated representative of their club.

Proxy Email *

List the email of your proxy.

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