Proxy Form - Fields Institute 2024 Annual General Meeting (AGM)

Fields Institute Proxy Form - 2024 Annual General Meeting

Fields Institute 2024 Proxy Form

In order to be validated, the proxy form must be completed including all mandatory fields as indicated by the * asterisk. Incomplete proxies will not be considered.

For information or assistance, contact us at governance@fieldsinstitute.ca

1. I, the undersigned Member of Corporation of the Fields Institute hereby appoint: *This question is required.

Please enter an 'other' value for this selection.

as my Proxy to attend and vote on my behalf at the virtual Annual General Meeting of the Members of the Corporation of the Fields Institute, to be held on Thursday, June 20, 2024 at 11:30 am, or at any adjournment thereof.

Proxy Holder Details

If you are appointing someone other than the Chair, Fields Institute Board of Directors/Designate as your proxy, you must complete the Proxy Holder details below for your proxy to be considered valid.

First Name *This question is required.

Last Name *This question is required.

Email Address *This question is required. This question requires a valid email address.

2. Your Contact Details

First Name *This question is required.

Last Name *This question is required.

Street Address (Business) *This question is required.

Apt/Suite/Office

City *This question is required.

Province/State/Region *This question is required.

Postal/Zip Code *This question is required.

Country *This question is required.

Please enter your email address *This question is required. This question requires a valid email address.

Please re-enter your email address *This question is required.

3. Sign here. *This question is required.

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