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DPNMI Proxy Registration Form
Registered
Active Members
can use this registration form to designate a Proxy to vote on their behalf.
The designated Proxy must be a registered
Active Member
of the DPNMI.
Proxy forms must be submitted on or before the date of the meeting at which a vote will occur.
Active Members can only hold
ONE
proxy.
This form is only valid for one DPNMI meeting where voting occurs.
If an Active Member wishes to appoint a Proxy for another meeting, they must submit a new form.
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* Indicates required question
Email
*
Your email
Active Member First Name
*
Your answer
Active Member Last Name
*
Your answer
Proxy Holder First Name
*
Your answer
Proxy Holder Last Name
*
Your answer
Proxy Holder Email
*
Your answer
Name of Meeting where Proxy voting will occur
*
Your answer
Proxy Type
A
General Proxy
can be voted on any matter that arises at the meeting, while a
Limited Proxy
can only be voted on the specific votes that you specify on your form.
*
General
Limited
Other:
IF LIMITED: Which vote(s) is your proxy limited to?
Your answer
Proxy Type (Uninstructed or Instructed)
An Instructed Proxy must be voted as recorded or “instructed” by the DNC member who has given the Proxy to another DNC Member, while a person carrying an Uninstructed Proxy may vote this Proxy any way he or she would like to vote.
*
Uninstructed
Instructed
IF INSTRUCTED: How should your proxy vote?
Please list the vote(s) that you would like your proxy to participate in, and how you instruct them to vote.
Your answer
A copy of your responses will be emailed to the address you provided.
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