Home / 2021 Virtual AGM Group Voting Authorization Form Home / 2021 Virtual AGM Group Voting Authorization Form 2021 Virtual AGM Group Voting Authorization Form Deadline: March 1st at 5pm EST: Which Region are you submitting this form for?* Southern Midwest Western Mid-Atlantic Northeast What type of Group are you submitting this form for?* Student Group Local Group What is the name and number of your Group? (School Groups do not have a number)* City:* State:* Group Coordinator/Chair Name:* First Last As the Group Coordinator/Chair, you are responsible for completing this form.Group Coordinator/Chair Phone Number:*Group Coordinator/Chair Email:* Group Delegate Name:* First Last Please provide the name of the person who will be responsible for the group voting card. This does not necessarily have to be the Group Coordinator/Chair. Group Delegate Phone Number:*Group Delegate Email:* Back-up to Group Delegate Name: First Last Should the Group Delegate be unable to pick-up the Group voting card, this person will also be permitted to pick-up the card on behalf of the Group. Back-up to Group Delegate Phone Number:2nd Back-up to Group Delegate Name: First Last Should the Group Delegate and the Back-up to the Group Delegate be unable to pick-up the Group voting card, this person will also be permitted to pick-up the card on behalf of the Group. 2nd Back-up to Group Delegate Phone Number:Has the Group discussed the resolutions?* All Some None CAPTCHA Δ