SPECIAL
POWER OF PROXY
City/State/Zip:_________________________________________
I
hereby appoint _____________________________________as my Agent, and provide
him/her with full power and authority to vote my proxy on any matters relating
to the Crow River Investment Club meeting on_________________________.
(date)
My Agent shall:
Not be liable for any loss that results from a judgment that was made in good
faith;
Not be entitled to any compensation for any services provided as Agent;
Provide an accounting for all acts performed as my Agent, if I so request, or if
such a request is made by an authorized personal representative or fiduciary
acting on my behalf.
_____________________________________________
Signature
Date
SPECIAL
POWER OF PROXY
Name:_______________________________________________
Address:_____________________________________________
City/State/Zip:________________________________________
I hereby appoint _____________________________________as my Agent, and provide
him/her with full power and authority to vote my proxy on any matters relating
to the Crow River Investment Club meeting on_________________________.
(date)
My Agent shall:
Not be liable for any loss that results from a judgment that was made in good
faith;
Not be entitled to any compensation for any services provided as Agent;
Provide an accounting for all acts performed as my Agent, if I so request, or if
such a request is made by an authorized personal representative or fiduciary
acting on my behalf.
_____________________________________________
Signature
Date
Click here to return to the Homepage of the Crow River Investment Club