Congregational Meeting Proxy Form

Members in Good Standing: If you are unable to join us for our Annual Congregational Meeting, Wednesday June 15, 2022 at 6:00 PM, please fill out this form to assign your proxy.

If you assign your proxy to anyone other than Board President Peter Mackler, please note they must be present at the virtual meeting and be a member in good standing to vote on your behalf. Individual members are able to hold two (2) proxies.

* First Name

* Last Name

* Email

* Mobile Phone

Proxy Assignment

Peter Mackler, Board PresidentOther (Please Indicate)

Name of Proxy

Please take note of restrictions above for proxies other than Peter Mackler.

* Digital Signature Acknowledgement

Digital Signature AcknowledgementAs a voting member of Congregation Kol Ami, I appoint Peter Mackler, Board President (or alternately, the person indicated above) as my proxy to vote on the items contained in the agenda. Checking this box affirms my signature on this proxy form.

Sat, June 7 2025
11 Sivan 5785

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Sat, June 7 2025 11 Sivan 5785