I.
Declarations:
(1) MEMBERSHIP: I hereby declare that I am a member in
good standing of the Seattle Community Network Association (SCNA), and
have been such continuously since March 25, 2001 or before.
(2) ELIGIBILITY: I declare that I know of no cause which
would render me ineligible to vote in this Seattle Community Network Association
election.
II. Proxy Nomination:
I hereby appoint the following person to vote in my stead
at the SCNA Annual Election to be held on April 25, 2001. I will transmit
a true and correct copy of this form to the person I designate as my proxy,
on or before the date of the election. The person I designate as my proxy
shall bring this completed form to the SCNA annual general meeeting, and
give it to the Association's Secretary or the person appointed by the Secretary
to gather ballots.
(Circle one choice below.)
(1) The natural person named ________________________,
who meets the MEMBERSHIP and ELIGIBILITY criteria shown
above. - OR -
(2) The Secretary of SCNA or the Secretary's designated
alternate.
This form may be completed and faxed to the Secretary
by 4 PM April 25, 2001 at 206-364-9872. This machine must be called by
another fax machine to work. It must hear a fax tone and not a dialtone
first. Please send your fax between the hours of 8 AM and 10 PM.
If you cannot fax and must e-mail this form to SCNA,
please send it to sharma@scn.org before
4 PM April 25, 2001, and include your voice phone number and postal mailing
address so that we may verify the authenticity of the e-mail.
III. Voting Instructions:
(Circle SPECIFIC or GENERAL authority below. For SPECIFIC,
circle the names of the candidates your proxy must vote for. You are eligible
to cast a total of four votes for four separate candidates.)
My proxy is instructed to cast my votes as follows:
(1) SPECIFIC PROXY: Cast my votes only for the candidate(s)
whose names I have circled below, and no others.
Board of Directors: (Circle up to four names.)
Adrienne Bailey
Randy Hayhurst
Ellen Earth
Ti Locke
(2) GENERAL PROXY: You may cast my votes as your judgment
dictates.
IV. Additional Voting Instructions to Proxy:
________________________________________________________________
________________________________________________________________
V. SCNA member/voter (i.e. you, who are giving instructions
to the proxy):
Name (Last, First): _________________________________
E-mail: ___________________________________________
Street Address: ____________________________________
City, State: ________________________________________
Phone: ___________________________________________
Signature: ________________________________________
SCNA Voting Proxy Form, Revised 03-01-2001.