Proxy Election Form

(click to download form)

 

 

 

PHILIPPINE COLLEGE OF RADIOLOGY

PROXY

KNOWN ALL MEN BY THESE PRESENTS:

That I, the undersigned member in good standing of the PHILIPPINE COLLEGE OF RADIOLOGY do hereby nominate, constitute and appoint _____________________________________, as my proxy to represent me, to vote for and in my behalf, in the election of members of the Board of Trustees of the PHILIPPINE COLLEGE OF RADIOLOGY scheduled on 28 February 2019 during the Philippine College of Radiology Annual Convention, SMX Convention Center, and to do all other things competent and proper to be done during the said meeting as fully as I could if personally present, giving to said proxy full power of substitution and revocation.

 

This proxy is good and valid only in my absence on 28 February 2019 and any postponement thereof.

 

IN WITNESS WHEREOF, I have extended this Proxy on ___________________.(date)

________________________________

Member

Witness:                                                         ________________________________