NALA Affiliated Association Designation of Proxy Form

Instructions and General Information

If you cannot vote online, you may designate NALA staff to cast your proxy vote.

Only the Affiliated Association Designated Voter shall be qualified to vote.

The Designation of Proxy form must be received by June 30, 2025.

By submitting this Designation of Proxy form, it will be sent to NALA for recording.

Form: Check which one applies(Required)

New Form

Revised Form

New Information: Check if this includes a new physical address, email address, or name change.

New

Voting Member Name(Required)

Previous Name: If the above name is new, indicate previous name in the box below.

Member Number

Control Number(Required)

Enter the number "873" in this box. This controls against forms that are completed automatically and are invalid.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

By clicking "SUBMIT" below, this form will be sent to NALA Headquarters.

Please select your candidate for Affiliated Associations Secretary.(Required)

Richard Hahn, ACP

Nita Serrano, ACP