First Unitarian Church

Proxy Vote Authorization

At

Annual or Special Congregational Meeting

Member unable to attend meeting:_______________________________

Reason attendance is not possible: _______________________________

Member being granted proxy:___________________________________

Date of meeting:______________________

Items for which proxy vote is authorized:__________________________________

Signature, e-signature or e-mail for verification purposes:

Date of request:______________________________________________

Please sign and print Name: ___________________________________

Board President or Designee: _____________________________

Board Secretary or Designee:______________________________

Date of Proxy Approval:__________________________

Note: Proxies do not count towards a meeting quorum. Attendance, whenever possible, is encouraged.

Form: 6/8/06