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Use this form to submit your vote or to elect the Chairman as your proxy.
Do not use this form if you are nominating a proxy (other than the Chairman)
Section 1 - Voting Declaration (tick either box)
A I wish to make my own vote (go to section 2)
B OR I wish to nominate the Chairman as my proxy who will vote 'For' all the resolutions (go to section 5)
Section 2 - Vote on Subscriptions and Fees
Membership Type
Deadline for Early Bird
50% Fee applies after
Playing Member
Student Member
Section 3 - Vote on Officers and sub-Committees of the Club
Office
sub-Committee
Your contact details MUST be completed to validate this form.
I am a Playing Member Non-Playing Member Student Member Vice-President of Headley Cricket Club.
Title
Name
Address
Work E-mail
Home E-mail
Work Phone
Mobile Phone
Home Phone
Other Phone
