CAPMR & CPRDF AGM Proxy Form 2022

A. Complete this section to appoint a Proxy Holder

CAPMR AGM Monday, June 20, 1830-2030

1. CAPM&R Member Email *This question is required. This question requires a valid email address.

2. Appointment of Proxy *This question is required.

I, (Your First Name/Last Name)

3. being a member of CAPM&R and entitled to attend and vote hereby appoint:
*This question is required.

Please enter an 'other' value for this selection.

4. Are you a member of CPRDF also?

as my proxy to act generally at the meeting on my behalf and to vote in accordance with the following directions (or if no directions have been given, as the proxy sees fit) at the CAPM&R & CPRDF Annual General Meetings on Mon. June 20, held virtually, from 1830 -2030 ET.